A young female patient with vague abdominal pain (2006: 4a)

Excerpt

A 33-year-old woman presented with a 1-year history of persistent diarrhoea and flank pain and was admitted since her condition had not responded to outpatient medication. At colonoscopy, elevated mucosal lesions were seen in the descending and sigmoid colon. Pneumatosis coli was suspected because the lesion shrank after puncture for biopsy, with no fluid or haemorrhage at the puncture site. The biopsy result revealed chronic inflammation, and the findings from the barium enema were normal. The patient was discharged without any treatment. One year later she was readmitted for treatment of haemorrhoids. Laboratory examinations revealed a low level of protein (4.1 g/dl; normal range 6.3–8.3 g/dl) and low albumin (2.3 g/dl; normal range 3.5–5.0 g/dl). Because of a diagnosed protein-losing enteropathy, computed tomography (CT) was performed. Abdominal CT showed infiltrating low attenuation masses in the sigmoid mesocolon, colonic wall and small bowel mesenteric root. There was no mass effect on adjacent organs and no enhancement after intravenous administration of contrast medium (Fig. 1a,b). Several cystic lesions in the spleen were noted on other CT images (Fig. 1c). Abdominal T1-weighted MR images showed heterogeneous low signal intensity lesions with a signal intensity similar to that of muscle (Fig. 2a). Abdominal T2-weighted images were more specific, showing a heterogeneous high signal intensity mass, which was infiltrating through the mesocolon, colonic wall and small bowel mesentery, best shown on coronal T2-weighted images (Fig. 2b,c).

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