What is the role of ultrasonography in the workup of Henoch-Schönlein purpura (IgA vasculitis)?

Updated: Jan 08, 2021
  • Author: Rajendra Bhimma, MBChB, MD, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Craig B Langman, MD  more...
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Abdominal ultrasonography may be used if GI symptoms are present. It may be better than barium enema for diagnosing intussusception, in that IgAV-related intussusception is more likely to be ileoileal than ileocolic (as is typical of idiopathic intussusception). Diagnosis of IgAV using ultrasonography and radionuclide scanning in a child presenting with bilateral acute scrotum as the main symptom has been reported. In children with GI involvement of IgAV, dedifferentiated wall thickening on ultrasonography reveals a poor clinical prognosis. [96]

Imaging of the scrotum by means of ultrasonography or a technetium radionuclide scanning may be necessary if scrotal edema is a presenting feature. Testicular ultrasonography may help in assessing the testes for hemorrhage or torsion. Doppler or radionuclide testicular scan results show normal or increased blood flow in IgAV, in contrast to the decreased blood flow seen in testicular torsion.

Bowel ultrasonographic findings include thickening of the bowel wall, free fluid, and intussusception. Hydrops of the gallbladder is rarely seen. Kidney involvement may not be evident on ultrasonography; if nephritis or nephrotic syndrome occurs, however, enlargement of the kidneys with loss of corticomedullary differentiation due to edema is observed.

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