Intestinal angioedema
Angioneurotic
oedema of the small bowel. Enhanced CT - Coronal reformat - soft tissue window reveals mural thickening and submucosal oedema of the gastric antrum with surrounding free fluid and prominent mesenteric vessels
Angioneurotic
oedema of the small bowel. Enhanced CT abdomen - axial view - soft tissue window
Angioneurotic
oedema of the small bowel. Enhanced CT abdomen - coronal reformat - soft tissue window - clear delineation of different layers of duodenal wall and fluid accumulation within dilated duodenum. There is surrounding free fluid.
Angioneurotic
oedema of the small bowel. Coronal reformat of enhanced CT abdomen - reveals free fluid accumulation.
Intestinal
angioedema • Hereditary angioedema - small bowel - Ganzer Fall bei Radiopaedia
Intestinal
angioedema • Small bowel angioedema (ACE-inhibitor related) - Ganzer Fall bei Radiopaedia
Intestinal
angioedema • Small bowel angioedema (ACE-inhibitor related) - Ganzer Fall bei Radiopaedia
Intestinal
angioedema • Small bowel angioedema (ACE-inhibitor related) - Ganzer Fall bei Radiopaedia
Intestinal angioedema is edema into the submucosal space of the bowel wall following protein extravasation from "leaky" vessels. It can affect both the small and large bowel.
Clinical presentation
Patients often present with non-specific findings of abdominal pain, nausea, and vomiting.
Pathology
There are three main types of intestinal angioedema:
- hereditary deficiency of C1-inhibitor enzyme
- acquired deficiency of C1-inhibitor enzyme (associated with B-cell lymphoproliferative disorders and autoimmune disease)
- medications
- angiotensin-converting enzyme inhibitors (ACEi)
- especially enalapril and lisinopril
- angiotensin II receptor blockers
- calcium channel blockers
- angiotensin-converting enzyme inhibitors (ACEi)
The exact mechanism of angioedema in the bowel is not completely understood, but it is thought to involve bradykinin pathways and subsequent vasodilation (instead of histamine pathways) during acute periods.
Radiographic features
CT
- bowel changes
- long segment concentric thickening of the bowel submucosa
- jejunum more often affected
- mural stratification
- straightening of bowel loops
- no obstruction
- long segment concentric thickening of the bowel submucosa
- mild mesenteric edema
- ascites
- no lymphadenopathy
Treatment and prognosis
In cases of medication-induced angioedema, removal of the offending agent usually results in complete resolution.
Differential diagnosis
- ischemic bowel
- lack of bowel wall enhancement
- possible pneumatosis
- bowel wall intramural hemorrhage: look for history of anticoagulation
- inflammatory bowel disease (e.g. Crohn disease)
- lymphoma: usually more irregular
- graft vs host disease: look for history of transplant and immunosuppression
Siehe auch:
Assoziationen und Differentialdiagnosen zu intestinales Angioödem: