Abstract
Purpose
Typhlitis, also known as neutropenic colitis, is a rare inflammatory condition and a potentially life-threatening disease process that typically involves the cecum. Delay in diagnosis may lead to a fatal prognosis with a death rate of 21–48%. Ultrasound evaluation of right lower quadrant may lead to an accurate and rapid diagnosis.
Methods
We describe the case of a 59-year-old female with advanced Churg–Strauss syndrome treated with cyclophosphamide, with acute right lower quadrant pain.
Results
Ultrasound was the first diagnostic step in the diagnosis of typhlitis. Sonographic findings were comparable to CT imaging.
Conclusions
Bowel bedside ultrasound evaluation in emergency settings may lead to a prompt and definitive diagnosis. Although CT is considered the gold standard in the diagnosis and staging of neutropenic colitis, ultrasound was able to identify the pathology accurately. Ultrasound findings of typhlitis are highly characteristic, showing circumferential wall thickening with predominant submucosa.
SOMMARIO
La tiflite, nota anche come colite neutropenica, è una rara forma di colite infiammatoria potenzialmente mortale (21–48%) che coinvolge il cieco, correlata ad alta mortalità se diagnosticata tardivamente. La tipica sintomatologia e localizzazione a livello cecale, rendono la valutazione ecografica e la conoscenza della patologia fondamentale, consentendo una diagnosi differenziale rapida ed efficace. Descriviamo il caso di una donna di 59 anni affetta da sindrome di Churg Strauss, in trattamento con ciclofosfamide che presentava dolore addominale localizzato al quadrante inferiore destro. L’ecografia della fossa iliaca destra ha dimostrato un quadro caratteristico e sovrapponibile ai reperti TC, con presenza di ispessimento e stratificazione parietale del ceco e dell’ultima ansa con prevalenza della sottomucosa. L’esame ecografico dell’intestino in emergenza è in grado di diagnosticare rapidamente ed efficacemente molte patologie intestinali acute, consentendo di differenziare tra patologie chirurgiche non chirurgiche. Nel caso della colite neutropenica, anche se La TC è ancora considerata il gold standard diagnostico, l’esame ecografico può identificare correttamente il quadro patologico ed essere una valido strumento diagnostico per il monitoraggio. I segni ecografici di tifilite sono estremamente caratteristici mostrando un incremento di spessore di parete circonferenziale con prevalenza ed iperecogenicità della sottomucosa.
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All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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It was a retrospective study. For this type of study, formal consent is not required, and all sensitive data were collected and protected in respect of present privacy statements.
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Tamburrini, S., Setola, F.R., Belfiore, M.P. et al. Ultrasound diagnosis of typhlitis. J Ultrasound 22, 103–106 (2019). https://doi.org/10.1007/s40477-018-0333-2
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DOI: https://doi.org/10.1007/s40477-018-0333-2