PMC4532082_01
A barium meal showing irregular luminal narrowing in the jejunum and ileum (arrow).
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The small bowel series revealed irregular segmental luminal narrowing in jejunum and ileum(Fig. 1).
Small intestinal enteroscopy performing under fluoroscopic guidance (A) and endoscopic findings showing multiple whitish granular spots scattered throughout the mucosa of the jejunum (B) and terminal ileum (C).
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Small intestinal endoscopic and colonoscopic study showed the presence of whitish granular spots scattered throughout the mucosa of the jejunum and terminal ileum(Fig. 2), but the esophagus, stomach, duodenum and colon showed normal findings.
Microscopic section reveals markedly dilated submucosal lymphatics without inflammation (arrow). H & E stain (x1000)
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Biopsy specimens taken from jejunum and terminal ileum revealed markedly dilated submucosal lymphatics with no evidence of inflammation (Fig. 3).
99mTc-HSA Scintigraphy: The radioactivity is noted in the heart, great vessels, liver and spleen at 30 minutes (A), in the right lower quadrant and transverse colon at 6 hours (B) and in the transverse and sigmoid colon at 24 hours (C) after intravenous injection of 99mTc-HSA.
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The activity was apparent in the right lower quadrant and transverse colon at 6 hours, and in the descending and sigmoid colon at 24 hours after injection, indicating a significant loss of serum protein into bowel lumen in this patient (Fig. 4).