Title: Differentiation of Crohn’s Disease and Intestinal Tuberculosis by Computed Tomography
Authors: R. Mithun Raj, Brahmadathan MN, Paul V Puthussery
Introduction and Background: Intestinal tuberculosis and Crohn’s disease are chronic granulomatous diseases that are commonly encountered in India. Crohn’s disease seems to be increasing now a day. Intestinal Tuberculosis and Crohn’s disease are difficult to differentiate because clinical, endoscopic and radiological manifestations of these diseases may be identical. This study aims to identify the CT features of Crohn’s disease and Intestinal Tuberculosis and assess the significance of CT findings in differentiating between these two diseases.
Materials and Methods: Descriptive study was done in Department of Radiodiagnosisfor a period of one and a half years with diagnosed 25 Crohn’s disease patients (as per ECCO guidelines 2010) &25 Intestinal Tuberculosis patients (as per modified Paustians criteria) who were referred for CT scan. Plain, oral and IV contrast CT abdomen were taken and the images were analyzed.
Results: CT features commoner in Crohn’s disease were skip lesions (p=0.01), hypervascular mesentery (0.002), fibrofatty proliferation of mesentery (0.01) &wall thickening in distal ileum (p=0.345) was common in Crohn’s disease than Intestinal Tuberculosis. CT features commoner in Intestinal Tuberculosis were mesenteric lymphadenopathy with central necrosis (p=0.01), high density ascites (p=0.004) &wall thickening in ileocecal junction was common in Intestinal Tuberculosis than Crohn’s disease but did not show statistical significance (0.377).
Conclusion: CT is useful in differentiating the Crohn’s disease and the Intestinal Tuberculosis.
Skip lesions, fibrofatty proliferation of mesentery, mesenteric hyper vascularity in Crohn’s disease are useful in differentiating it from the Intestinal Tuberculosis.
Mesenteric lymph nodes with central necrosis, high density ascites in Intestinal Tuberculosis are useful in differentiating it from the Crohn’s disease.
Keywords: Crohn’s disease; Intestinal Tuberculosis; computed tomography.