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Intestinal ischemia versus intramural hemorrhage: CT evaluation
Michael Macari1, Hersch Chandarana, Emil Balthazar
1Department of Radiology, Abdominal Imaging Section, Tisch Hospital, New York University Medical Center, 560 First Avenue, Ste. HW 207, New York, NY 10016, USA.
AJR. American Journal of Roentgenology
|December 20, 2002
Summary
Computed tomography (CT) can differentiate small-bowel ischemia from intramural hemorrhage. Intramural hemorrhage typically presents as short segment involvement with thick walls, while ischemia shows long segment involvement with thin walls.
Area of Science:
- Radiology
- Gastroenterology
- Abdominal Imaging
Background:
- Small-bowel ischemia and intramural hemorrhage are critical conditions that can present with similar symptoms.
- Accurate differentiation is crucial for timely and appropriate treatment.
Purpose of the Study:
- To evaluate the capability of computed tomography (CT) in differentiating small-bowel ischemia from intramural hemorrhage.
- To identify specific CT findings indicative of each condition.
Main Methods:
- Retrospective analysis of 35 CT examinations (19 small-bowel ischemia, 16 intramural hemorrhage).
- Radiologists assessed wall thickening, length of involvement, hemoperitoneum, and the target sign.
- Statistical tests (Mann-Whitney U, Fisher's exact) compared features between the two groups.
Main Results:
- Intramural hemorrhage showed significantly greater wall thickening (11.7 mm vs 4.0 mm) and shorter segment involvement (<15 cm) compared to ischemia.
- Hemoperitoneum was more frequent in intramural hemorrhage (94% vs 32%).
- The target sign was present in both but not statistically different.
Conclusions:
- Short segment involvement with wall thickening ≥1 cm suggests intramural hemorrhage.
- Long segment involvement with wall thickening <1 cm is typical of ischemia.
- CT can effectively distinguish between these two conditions based on specific imaging features.