Significance of bowel wall abnormalities at ultrasound in Henoch-Schönlein purpura.
OBJECTIVE
To describe the polymorphism of intestinal ultrasound findings in children with gastrointestinal symptoms of Henoch Schönlein purpura (HSP) and to investigate the clinical relevance of these findings in terms of symptoms and length of hospitalization.


METHODS
Clinical and ultrasound data from 43 consecutive children with HSP (36 with and 7 without abdominal symptoms) were reviewed. Patients with abdominal symptoms of HSP were divided into 4 groups (0-III) representing at ultrasound normal appearance and differentiated, pseudodifferentiated, and dedifferentiated bowel wall thickening, respectively. The diagnostic value of ultrasound in diagnosing gastrointestinal involvement of HSP (grades I-III) was calculated using as the standard of reference the absence or presence of clinical symptoms. Average duration of symptoms and hospitalization in the 4 groups was compared.


RESULTS
The respective sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound for the diagnosis of gastrointestinal involvement of HSP was 83.3%, 100%, 100%, and 53.8%. Groups 0 to III contained, respectively, 5/36 (13.9%), 6/36 (16.7%), 22/36 (61.1%), and 3/36 (8.3%) patients. The groups' average duration of symptoms, respectively, was 2.20 +/- 2.06, 5.67 +/- 1.88, 6.29 +/- .94, and 17.67 +/- 2.66 days, whereas the length of hospitalization, respectively, was 4.80 +/- 2.96, 9.17 +/- 2.70, 11.46 +/- 1.35, and 24.67 +/- 3.82 days. The duration of both symptoms and hospitalization was significantly higher in group III than in the other groups (P < 0.05).


CONCLUSIONS
In children with gastrointestinal involvement of HSP, dedifferentiated wall thickening as shown by ultrasound is associated with a poor clinical prognosis.
Nchimi
Alain
A
Medical Imaging Department, CHC, Rue de Hesbaye, 75, 4000 Liège, Belgium. alain.nchimi@chc.be
Khamis
Jamil
J
Paquot
Isabelle
I
Bury
Françoise
F
Magotteaux
Paul
P
D015746:Abdominal Pain; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007422:Intestines / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D007902:Length of Stay; D008297:Male; D012680:Sensitivity and Specificity; D014463:Ultrasonography