Differential Diagnosis for Decreased Bowel Mucosal Enhancement
- Single most likely diagnosis
- Non-occlusive mesenteric ischemia (NOMI): This condition occurs when there is a reduction in blood flow to the intestines without a physical blockage of the major arteries. The symptoms and imaging findings, such as decreased bowel mucosal enhancement and mesenteric edema without large vessel occlusion, align with NOMI, making it a highly plausible diagnosis.
- Other Likely diagnoses
- Venous thrombosis: Although less common than arterial occlusions, venous thrombosis can cause bowel ischemia by obstructing blood flow out of the intestines. The presence of mesenteric edema and decreased mucosal enhancement could suggest this diagnosis.
- Low-flow state: Conditions that lead to a systemic decrease in blood flow, such as heart failure or severe dehydration, can result in decreased perfusion of the bowel, leading to ischemia. This diagnosis would be considered if there were systemic signs of low perfusion.
- Vasculitis: Inflammation of the blood vessels supplying the intestines can lead to ischemia. While less common, it should be considered, especially if there are other systemic signs of vasculitis.
- Do Not Miss diagnoses
- Embolic event: Although the question states no large vessel occlusion, it's crucial to thoroughly investigate for any signs of emboli, as missing this could lead to severe consequences, including bowel infarction.
- Thrombotic event: Similar to embolic events, thrombotic occlusions of smaller vessels might not be immediately visible but could lead to significant ischemia.
- Sickle cell crisis: In patients with sickle cell disease, a crisis can lead to vaso-occlusive episodes affecting any organ, including the bowel, resulting in ischemia.
- Rare diagnoses
- Fibromuscular dysplasia: A rare condition affecting the medium and large arteries, which could potentially lead to bowel ischemia if the mesenteric arteries are involved.
- Radiation enteritis: Previous radiation therapy can lead to chronic changes in the bowel, including ischemia due to damage to the blood vessels. This would be considered in patients with a history of abdominal radiation.
- Cholesterol crystal embolization: A rare condition where cholesterol crystals break off from plaques in the aorta and embolize to smaller vessels, potentially causing ischemia.