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Society for Pediatric Radiology – Poster Archive

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Al-busaidi Asya,  Al-shabibi Saud

Final Pr. ID: Poster #: CR-025

During the past one year we encountered three previously healthy children ages 10,8 and 2 years respectively who presented with localized colicky abdominal pain of few days duration. All three patients had eosinophilia ,one of whom had an associated fever and a high white blood cell count. Firm tender masses were palpated in the right side of their abdomens.
Their abdominal ultrasounds showed well defined hypoechoic masses with central components of gaseous artefacts, indicating bowel loop involvement. Computed tomography then done, showed aneurysmal dilatation with mural circumferential thickening of the ascending colon. The affected bowel loops were attenuating, showed perilesional fat stranding and multiple mesenteric lymph nodes some of which showed signs of necrosis. Neoplastic and infectious causes were therefore entertained.
Gastrointestinal lymphoma would show such aneuryusmal dilatation with mural thickening. However 50% of these affects the ileo-caecal segment. Moreover, our patients did not exhibit any symptoms or laboratory findings suggestive of a malignant process.
The presence of necrotic lymph nodes geared towards tuberculosis. However, again this is most commonly seen in the ileocecal segment. Since the patients were not septic and had high eosinophil count, atypical infections were considered. Having come across some reported cases of basidobolomycosis from the Arabian peninsula we therefore put this diagnosis at the top of our differentials.
The patients underwent hemicolectomies and were all confirmed histologically to have characteristic features of basidobolomycosis. In retrospective review of the patients' files we did observe that they were all from the coastal region of Oman.
The main objectives of this report is to draw the attention that such rare fungal infections are not uncommon in our country and the region and to enlighten the importance of a broad systematic approach when considering the various aetiological causes of focal bowel thickening including rare diseases that may be endemic in certain areas.
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Authors:  Al-busaidi Asya , Al-shabibi Saud

Keywords:  Gastrointestinal, Basidobolomycosis, Oman, Focal, Thickening