Intramural Fat in the Duodenum and Proximal Small Intestine in Patients with Celiac Disease

doi:10.2214/AJR.07.2109

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Intramural Fat in the Duodenum and Proximal Small Intestine in Patients with Celiac Disease

Francis J. Scholz¹, Spencer C. Behr and Christopher D. Scheirey

¹ All authors: Department of Diagnostic Radiology, Lahey Clinic, 41 Mall Rd., Burlington, MA 01805.

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Fig. 1A —81-year-old woman (patient 1) who underwent virtual colonoscopy screening for colorectal cancer. Review of her chart showed much earlier proven diagnosis of celiac disease that had not been noted in chart for decades. Medical history also included psoriatic arthritis treated with methotrexate. and CT scans show thick layer of intramural duodenal fat. Penetration of common bile duct (arrow) through wall to mucosa is seen (A). Coronal reconstruction also defines penetration of duct (arrow) across layer of intramural fat (B).

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Fig. 1B —81-year-old woman (patient 1) who underwent virtual colonoscopy screening for colorectal cancer. Review of her chart showed much earlier proven diagnosis of celiac disease that had not been noted in chart for decades. Medical history also included psoriatic arthritis treated with methotrexate. and CT scans show thick layer of intramural duodenal fat. Penetration of common bile duct (arrow) through wall to mucosa is seen (A). Coronal reconstruction also defines penetration of duct (arrow) across layer of intramural fat (B).

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Fig. 1C —81-year-old woman (patient 1) who underwent virtual colonoscopy screening for colorectal cancer. Review of her chart showed much earlier proven diagnosis of celiac disease that had not been noted in chart for decades. Medical history also included psoriatic arthritis treated with methotrexate. Axial slice distal to A shows fat in duodenal folds creating linear array (arrows) of perpendicularly oriented deposits of fat.

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Fig. 1D —81-year-old woman (patient 1) who underwent virtual colonoscopy screening for colorectal cancer. Review of her chart showed much earlier proven diagnosis of celiac disease that had not been noted in chart for decades. Medical history also included psoriatic arthritis treated with methotrexate. Upper gastrointestinal series performed for pain 1 year before A and B shows a scarred duodenum with diverticula (arrows) but no ulceration.

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Fig. 2A —65-year-old woman (patient 2) with known celiac disease and iron deficiency anemia. Her medical history includes seasonal allergies, gastroesophageal reflux disease, and hyperlipidemia. and Upper gastrointestinal barium studies show fold-free duodenum with "bubbly" bulb (arrow, A) and featureless appearance of jejunum (B), where weblike strictures indicate active celiac disease.

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Fig. 2B —65-year-old woman (patient 2) with known celiac disease and iron deficiency anemia. Her medical history includes seasonal allergies, gastroesophageal reflux disease, and hyperlipidemia. and Upper gastrointestinal barium studies show fold-free duodenum with "bubbly" bulb (arrow, A) and featureless appearance of jejunum (B), where weblike strictures indicate active celiac disease.

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Fig. 2C —65-year-old woman (patient 2) with known celiac disease and iron deficiency anemia. Her medical history includes seasonal allergies, gastroesophageal reflux disease, and hyperlipidemia. CT scans of thorax 4 years after A and B show layer of intramural fat in duodenum (straight arrow) and jejunum (curved arrows).

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Fig. 3A —78-year-old woman (patient 3) with known adult-onset celiac disease and right-sided abdominal pain. Her medical history includes asthma occasionally treated with prednisone, recurrent sinusitis, and gastroesophageal reflux disease. and Upper gastrointestinal barium studies show celiac disease with "bubbly" nodularity in bulb and in fold-free duodenal sweep (arrows). Malabsorption pattern was also seen.

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Fig. 3B —78-year-old woman (patient 3) with known adult-onset celiac disease and right-sided abdominal pain. Her medical history includes asthma occasionally treated with prednisone, recurrent sinusitis, and gastroesophageal reflux disease. and Upper gastrointestinal barium studies show celiac disease with "bubbly" nodularity in bulb and in fold-free duodenal sweep (arrows). Malabsorption pattern was also seen.

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Fig. 3C —78-year-old woman (patient 3) with known adult-onset celiac disease and right-sided abdominal pain. Her medical history includes asthma occasionally treated with prednisone, recurrent sinusitis, and gastroesophageal reflux disease. Three years later, after patient reported progressive shortness of breath, CT scans show fine line of intramural fat density (arrows) in jejunum in addition to intramural duodenal fat.

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Fig. 4 —37-year-old man (patient 4) with no significant medical history and right lower quadrant pain. Abdominopelvic CT scans show intramural fat in duodenum (straight arrows) and jejunum (curved arrows). Small-bowel biopsies led to diagnosis of celiac disease.

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