Whipple's disease is an uncommon malabsorption disorder which is generally diagnosed by barium contrast studies, laboratory and histologic examin a t i o n ~. ~, ~. ~ Ultrasound has been recently recommended in the detection of gastrointestinal tumors, inflammatory and neoplastic infiltrations of the intestinal walls, and Crohn's disease, not as a substitute for contrast radiography, but as an adjunct and precursor to other, more invasive t e ~t s . ~, ~, ~
The ultrasonic findings of Whipple's disease, not described previously to our knowledge, are the subject of this presentation.
Methods
Real-time sonographic examination was performed with a commercially available gray-scale ultrasound scanner (Aloka SSD-2561, using a 3.5 MHz linear transducer. All abdominal quadrants were investigated in the fasting patient without any special preparation using longitudinal, transverse and oblique scans.
CASE REPORT
A 54-year-old man was admitted with diffuse abdominal pain, diarrhea with steatorrhea (10 times daily), severe anorexia, moderate fever, and marked weight loss which had developed over a period of 4 months. Physical examination revealed nontender, slightly enlarged axillary and inguinal lymph nodes, brown skin pigmentation, edema, ascites and diffuse abdominal tenderness, especially on the left lower quadrant.
Laboratory findings were characterized by
From the Department of Internal Medicine and the Department of Radiology,*