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Enterocolitis: prodrome of the hemolytic-uremic syndrome
Insights
Ischemic enterocolitis can precede characteristic signs of hemolytic-uremic syndrome (HUS). Radiographic findings like thumbprinting may suggest HUS before renal or hematologic abnormalities appear, aiding earlier diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Nephrology
- Diagnostic Radiology
Background:
- Ischemic enterocolitis is a common prodrome in over 80% of hemolytic-uremic syndrome (HUS) cases.
- Delayed diagnosis of HUS can occur when enterocolitis precedes typical laboratory findings or oliguria.
- Severe enterocolitis may mask underlying renal impairment, complicating early HUS detection.
Purpose of the Study:
- To highlight the diagnostic utility of radiographic findings in early HUS detection.
- To emphasize the role of radiologists in suggesting HUS before definitive clinical signs emerge.
- To improve the timeliness of HUS diagnosis in pediatric patients presenting with enterocolitis.
Main Methods:
- Retrospective analysis of two pediatric cases with ischemic enterocolitis and subsequent HUS.
- Review of radiographic findings, including plain radiographs and barium enema examinations.
- Correlation of radiographic signs with clinical presentation, laboratory results, and renal function.
Main Results:
- Radiographic "thumbprinting" was observed in both cases.
- Thumbprinting suggested HUS as a potential diagnosis prior to the manifestation of renal or hematologic abnormalities.
- Early suspicion based on imaging findings facilitated prompt management considerations.
Conclusions:
- Radiographic findings such as thumbprinting are valuable indicators for suggesting hemolytic-uremic syndrome in children with ischemic enterocolitis.
- Early identification of HUS through imaging can potentially mitigate disease severity and improve outcomes.
- Radiologists play a crucial role in the early diagnostic pathway of HUS.
Abstract:
Two children presented with ischemic enterocolitis, a prodrome that occurs in 80% or more of patients with the hemolytic-uremic syndrome. When the prodrome precedes the development of characteristic laboratory findings or oliguria, the diagnosis of the hemolytic-uremic syndrome often is delayed. The severity of the enterocolitis itself may overshadow renal impairment. Findings of thumbprinting on plain radiographs or on barium enema examinations allow the radiologist to suggest the hemolytic-uremic syndrome as a possible cause before renal or hematologic abnormalities become manifest.