Zusammenfassung
Ziel: Der Begriff „white bowel” wurde erstmals von uns bei einem Patienten mit HIV-assoziierter Enteropathie und Mycobacterium avium-intracellulare-Infektion geprägt. Ziel der Arbeit war die genaue Beschreibung der echoreichen Darmwandveränderungen und die Darstellung möglicher Ursachen. Material und Methoden: Insgesamt wurden die Daten von zehn Patienten ausgewertet, bei denen wir dieses Phänomen beobachtet haben und die in Bilddatensammlungen erfasst waren. Besonderes Augenmerk wurde auf die Echogenität der einzelnen Darmwandschichten und auf Veränderungen im Mesenterium wie Lymphknotenvergrößerungen und Venenthrombosen gelegt. Ergebnisse: Bei den erfassten zehn Fällen handelte es sich um Patienten mit Mycobacterium avium-intracellulare-Infektionen (n = 3), einheimischer Sprue und T-Zell-Lymphom (n = 2), Karzinomen des Dünn- und Dickdarms (n = 3) und Morbus Whipple (n = 2). Typisch war eine echoreich verdickte Dünndarmwand, vor allem die Mukosa und teilweise auch die Submukosa betreffend. Begleitend war fast immer eine deutliche echoarme oder seltener auch echoreiche mesenteriale Lymphadenopathie zu beobachten. In drei Fällen lag auch eine Mesenterialvenenthrombose vor. Schlussfolgerung: Das Phänomen der weißen Darmwand trat bei verschiedenen Erkrankungen auf, wobei in der Mehrzahl auch eine deutliche mesenterielle Lymphadenopathie vorhanden war. Dies lässt einen Zusammenhang mit einem Lymphaufstau des Darms vermuten.
Abstract
Aim: We recently introduced the term “white bowel” to describe the hyperechoic appearance of the bowel wall found in a patient with HIV-associated enteropathy. The aim of this study was to describe changes of the bowel wall and to demonstrate possible causes of this phenomenon. Patients and Methods: 10 patients identified as showing this phenomenon were enrolled in this study. The ultrasound examinations of the patients were re-evaluated with special regard to the echogenicity of the different layers of the bowel wall, to mesenteric lymph nodes, and to thrombosis of the mesenteric vein. Results: Diagnosis in these 10 patients included: HIV-associated enteropathy aggravated by Mycobacterium avium-intracellulare infection (n = 3); endemic coeliac disease and complications arising from T-cell lymphoma (n = 2); carcinoma of the small and large intestine (n = 3); Whipple’s disease (n = 2). Sonography typically showed echogenic thickening of the wall of the small intestine - mainly of the mucosal layer. Enlarged mesenteric lymph nodes (with both hypoechoic and occasionally hyperechoic appearance) were present in the majority of cases. In 3 cases, mesenteric vein thrombosis was also demonstrable. Conclusion: The “white bowel” was found in patients with different diseases. Most of the patients showed enlargement of the mesenteric lymph nodes. Lymph oedema of the bowel wall probably constitutes the main reason for this phenomenon.
Schlüsselwörter
Sonographie - Lymphödem - Darmerkrankungen - M. Whipple - Mycobacterium avium-intracellulare-Infektion
Key words
Ultrasonography - lymph oedema - intestinal diseases - Whipple disease - mmycobacterium avium-intracellulare infection
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OA Dr. Alois Hollerweger
Abteilung für Radiologie und Nuklearmedizin, KH Barmherzige Brüder
Kajetanerplatz 1
A-5020 Salzburg
Phone: ++ 43/6 62/80 88
Fax: ++ 43/6 62/84 04 64
Email: alois.hollerweger@bbsalz.at
