Penetrating Crohn disease: does it occur in the absence of stricturing disease?

PURPOSE: To establish the relationship between penetrating complications and bowel luminal narrowing/stricturing disease in pediatric Crohn disease (CD). MATERIALS AND METHODS: This retrospective study was IRB-approved and HIPAA compliant with waiver of informed consent. CT and MRI examinations describing intra-abdominal penetrating complications in CD patients ≤ 18 years old between January 1, 2009 and March 31, 2016 were reviewed to document: type of complication, affected bowel segment, minimum bowel luminal diameter, maximum upstream diameter, location of penetrating complication relative to luminal narrowing, length of narrowed bowel segment, and the presence of active bowel wall inflammation. Data were summarized using descriptive statistics including means, standard deviations, as well as counts and percentages. RESULTS: A total of 52 penetrating complications were identified in 45 patients. Mean patient age was 15.7 ± 2.2 years (range 11-18 years) with 25/45 (56%) boys. Nearly all penetrating complications (51/52, 98%) were associated with a minimum bowel luminal diameter of ≤ 2 mm, with no visible lumen in 26/52 (50%). Mean maximum upstream diameter was 2.8 ± 0.8 cm (range 1.2-5.2 cm), and 17/52 (33%) penetrating complications were associated with > 3 cm upstream diameter. The mean ratio of maximum to minimum luminal diameter was 26.2 ± 8.8 (range 3.6-52.0). Active intestinal inflammation was associated with 100% (52/52) of penetrating complications. Nearly every penetrating complication (51/52, 98%) involved the terminal or distal ileum. CONCLUSIONS: Penetrating complications in pediatric CD nearly always occur in the setting of considerable luminal narrowing or stricture and active intestinal inflammation.

Masses of the Nose, Nasal Cavity, and Nasopharynx in Children.

A wide range of masses develop in the nose, nasal cavity, and nasopharynx in children. These lesions may arise from the nasal ala or other structures of the nose, including the mucosa covering any surface of the nasal cavity, the cartilaginous or osseous portion of the nasal septum, the nasal turbinates, and the nasal bones. Lesions may also arise from the nasopharynx or adjacent structures and involve the nose by way of direct extension. The causes of nasal masses in children include congenital and developmental disorders such as congenital nasolacrimal duct mucocele, dermoid cyst, cephalocele, and nasal neuroglial heterotopia; inflammatory and infectious processes such as mucocele, polyp, and pyogenic granuloma; benign neoplasms such as infantile hemangioma and juvenile nasopharyngeal angiofibroma; malignant lesions such as rhabdomyosarcoma and nasopharyngeal carcinoma; and masses related to prior trauma such as septal hematoma. Although direct visualization, without imaging, is frequently sufficient to diagnose pediatric nasal conditions, in many cases imaging has a key role in the treatment of the affected child. Some of these lesions have characteristic computed tomography and/or magnetic resonance imaging findings, some of them are diagnosed on the basis of the location and imaging findings combined, and others demonstrate nonspecific imaging findings. However, imaging is important for better defining the total extent of the lesion and guiding the clinician in determining whether medical and/or surgical intervention is required. In this article, the authors review the imaging findings of the most common causes-and many of the not-so-common causes-of nasal masses encountered in the pediatric population. ©RSNA, 2017.