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Differential Diagnosis

Clinically, local tenderness, fever, and leukocytosisi may favor infection, but advanced neoplasms may perforate the bowel wall and cause a localized inflammatory reaction. It is usually possible with ultrasonography to define local or circumferential thickening of the bowel wall (a hypoechoic or an echoic mass) with a central or eccentric lumen (a bright linear echo caused by the mucosa). This is most often due to infection, such as tuberculosis (Fig. 48.22 A, B) or amebiasis. Crohn's disease (Fig. 48.22 C, D) is not common in some countries, but lymphoma and other neoplasms can produce the same ultrasound appearance.

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Fig. 48.22. (A, B) Tuberculous enteritis. (C, D) Crohn's disease of terminal ileum. L lumen; BO bowel; LN lymph node.

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