Purpose or Case Report: Ulcerative colitis (UC) and Crohn disease are chronic, immune-mediated, inflammatory disorders of the gastrointestinal tract collectively referred to as inflammatory bowel disease (IBD). As many of 20-25% of patients with IBD initially present in childhood or adolescence, and the incidence of pediatric IBD is increasing. IBD primarily affects the bowel, but other organs can be involved. Nearly one-third of patients will have at least one extra-intestinal manifestation. Some extra-intestinal manifestations, such as that between UC and primary sclerosing cholangitis (PSC), are well-established. Others are less understood and may mimic more common pathology, particularly infection. Therefore, pediatric radiologists must become familiar with these extra-intestinal manifestations and consider the diagnosis of IBD as the etiology for their pathology.
Methods & Materials: A case review of the imaging features of some common and uncommon extra-intestinal manifestations of pediatric IBD will be presented. A brief overview of pediatric IBD, its pathophysiology, clinical features, and the key imaging findings on various modalities will be provided. The role of imaging as a whole in making the diagnosis and guiding the management of IBD will also be described.
Results: In this educational exhibit, a series of cases will be presented to illustrate the imaging findings in pediatric IBD with emphasis on the extra-intestinal manifestations. We will review some well-known manifestations of IBD such as primary sclerosing cholangitis (PSC) and IBD related spondyloarthropathies, and highlight their key imaging characteristics. Additionally, we will also present cases of some uncommon extra-intestinal manifestations such as granulomatous hepatic abscesses and non-infectious lung parenchymal involvement, which may mimic other disease entities thus creating potential pitfalls for the radiologist.
Conclusions: Pediatric IBD is frequently associated with extra-intestinal involvement. These findings may be discovered when imaging the bowel or IBD may be suspected based on the combination of intestinal and extra-intestinal findings. It is therefore important for radiologists to consider these manifestations to provide an accurate assessment of the patient to the referring physician.