Pediatric Henoch-Schonlein Purpura

  • Etiology: Immune mediated small vessel vasculitis which causes edema and submucosal and intramural hemorrhage in bowel
  • Imaging:
    — Gastrointestinal: Bowel wall thickening (thumbprinting), decreased motility, multiple small bowel-small bowel intussusceptions, bowel perforation, bloody ascites
    — Genitourinary: Scrotal edema, epididymitis
  • Imaging MRI: Vessel wall thickening and enhancement
  • DDX:
  • Complications:
  • Treatment:
  • Clinical:
    — Most common pediatric vasculitis
    — In 3-15 years old but most common between 2-6 years old
    — Clinical triad = skin rash (palpable purpura which are mandatory for diagnosis) in 100%, arthritis in 75%, abdominal pain in 50%
    — Gastrointestinal manifestations in 66%, renal disease in 25%

Radiology Cases of Henoch-Schonlein Purpura

CT of Henoch-Schonlein purpura
Axial (above), coronal (below) and sagittal (right) CT with contrast of the abdomen shows a thickened mildly enhancing loop of proximal jejunum in the anterior midline of the abdomen. There is also a small amount of ascites present
Small bowel follow through of Henoch-Schonlein purpura
AXR AP (left) and spot image of the terminal ileum (right) from a small bowel follow through show bowel wall fold thickening (thumbprinting) throughout the jejunum and ileum.
US of epididymitis secondary in Henoch-Schonlein Purpura
Transverse color doppler US of the scrotum shows enlargement and hypervascularity of the bilateral crescent shaped epididymides when compared to their respective round testicles, to which they are lateral in position.

Clinical Cases of Henoch-Schonlein Purpura

Clinical image of Henoch-Schonlein purpura
Clinical image shows the lower extremities to be covered with purple-colored palpable purpura.