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Henoch-Schonlein Purpura

Henoch-Schonlein is a type of hypersensitivity vasculitis and inflammatory response within the blood

Fig. 5.27. A boy with cystic fibrosis complicated with distal intestinal obstruction syndrome. Note the dilated intestinal loops and huge fecal impaction in the terminal ileum and caecum

vessel. It is caused by an abnormal response of the immune system. The syndrome is usually seen in children and is more common in boys (Parker 2003).

Clinical symptoms are purple spots on the skin, joint pain, gastrointestinal symptoms and glomer-ulonephritis. Gastrointestinal symptoms include abdominal pain, nausea, vomiting, diarrhea and bloody stools. Bleeding into the bowel wall occurs in about half of patients and may act as a lead point for intussusception.

Routine abdominal radiographs (Fig. 5.29a) give no significant information and are not recommended, unless perforation is clinically suspected.

Ultrasound is the imaging modality of choice and will show thickened bowel wall, ascites, ileus of affected loops, bowel dilatation and possible entero-enteric intussusceptions (Fig. 5.29b) (ConnoLLY and O'HALpin 1994).

Fig. 5.28. Intestinal tuberculosis. CT scan shows the heterogenic, hypodense masses with peripheral ringlike calcifications following lymphadenitis and ascites

Fig. 5.29. a Supine abdominal film of a child with Henoch-Schonlein. Note the intestinal wall thickening on plain film. b-d A patient with Henoch-Schonlein disease. The thickened wall is demonstrated by ultrasound d b

Fig. 5.29. a Supine abdominal film of a child with Henoch-Schonlein. Note the intestinal wall thickening on plain film. b-d A patient with Henoch-Schonlein disease. The thickened wall is demonstrated by ultrasound b

References

Agrons GA, Corse WR, Markowitz RI et al. (1996) Gastrointestinal manifestations of cystic fibrosis: radiologic-pathologic correlation. Radiographics 16:871-893

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Berrocal T, Lamas M, Gutieerrez J et al. (1999) Congenital anomalies of the small intestine, colon, and rectum. Radiographics 19:1219-1236

Boudiaf M, Soyer P, Terem C et al. (2001) CT evaluation of small bowel obstruction. Radiographics 21:613-624 (review)

Carty H, Brunelle F, Stringer D, Kao S (2005) The gastrointestinal tract. In: Carty H, Brunelle F, Stringer D, Kao S (eds) Imaging children, 2nd edn, vol. 2. Elsevier Churchill Livingston, pp 1289-1545

Chaudry G, Navarro OM, Levine DS, Oudjhane K (2006) Abdominal manifestations of cystic fibrosis in children. Pediatr Radiol 36:233-240

Connolly B, O'Halpin D (1994) Sonographic evaluation of the abdomen in Henoch-Schönlein purpura. Clin radiol 49:320-323

De Backer AI, Mortele KJ, Deeren D et al. (2005) Abdominal tuberculosis lymphadenopathy: MRI features. Eur Radiol 15:2104-2109

Devos A, Meradji M (2003) Werkboek Kinderradiologie. Hoofdstuk VII: Maag-Darmkanaal. 2003 pp 72-99

Engin G, Balk E (2005) Imaging findings of intestinal tuberculosis. J Comput Assist Tomogr 29:37-41 Frokjaer JB, Larsen E, Steffensen E, Nielsen AH, Drewes AM (2005) Magnetic resonance imaging of the small bowel in Crohn's disease. Scand J Gastroenterol 40:832-842 Grier D (1999) Radiology of pediatric gastrointestinal emergencies. In: Carty H (ed) Emergency pediatric radiology. Springer, Berlin Heidelberg New York, pp 117-182 Husband JE, Reznek RH (2004) Imaging in oncology, 2nd edn, parts III and IV. Taylor and Francis, London, pp 817874 and pp 921-998 Jain R, Sawhney S, Bhargava DK, Berry M (1995) Diagnosis of abdominal tuberculosis: sonographic findings in patients with early disease. AJR Am J Roentgenol 165:1391-1395 Lardenoye SW, Puylaert JB, Smit MJ, Holscher HC (2004) Appendix in children with cystic fibrosis: US features. Radiology 232:187-189 Nicolaou S, Kai B, Ho S et al (2005) Imaging of acute small bowel obstruction. AJR Am J Roentgenol 185:1036-1044 (review) Ortiz C, Cleveland RH, Blickman JG, Jaramillo D, Kim SH (1990) Familial superior mesenteric artery syndrome. Pediatr Radiol 20:588-589 Parker BR (2003) Abdominal and gastrointestinal tract, small intestine. In: Kuhn J, Slovis T, Holler J (eds) Caffey~s pediatric diagnostic imaging, 10th edn. Mosby, Philadelphia . pp 1616-1648 Strouse PJ, DiPietro MA, Saez F (2003) Transient small-bowel intussusception in children on CT. Pediatr Radiol 33:316-320

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