GI Radiography


Case 16 :
A 60-year-old female, known asthmatic, presented to the Emergency department with fever and abdominal pain. She had been hospitalized 2 months ago for an acute lower respiratory tract infection and breathlessness, for a period of 8 days. Ultrasound scan was done for present abdominal pain, and was normal. WBC count is 15,000. Patient is HIV negative. CT abdomen is requested. What is the diagnosis?

Click here for bigger picture

Click here for bigger picture

Click here for bigger picture

Fig 1   Fig 2   Fig 3  
________SCROLL FOR ANSWER__________






Imaging Findings

Study shows thickened wall of the entire colon, with pericolic fluid collections and fat inflammation. Minimal free fluid is seen in the abdomen. Small bowel was normal. In view of previous history of hospitalization for respiratory tract ailment, and antibiotic and steroid usage, a diagnosis of pseudomembranous colitis was suggested, that was subsequently confirmed on colonoscopy and histopath examination.
are necessary for diagnosis.

Diagnosis:

Pseudomembranous colitis

Discussion:

The lesions of Pseudomembranous Enterocolitis (PMC) when secondary to antibiotic usage with C.difficile toxin production are usually restricted to the colon, with non-antibiotic associated cases often involving the small intestine. Most antibiotics can cause this. They kill the normal flora, and allow Clostridium difficile to overgrow.

CT is of limited value in the evaluation of colitis, as there is a wide overlap in most cases. Though the double halo sign or target sign was described for ulcerative colitis, it is also seen in Crohn's disease, radiation colitis, neutropenic colitis, and in AIDS patients with cytomegalovirus colitis. This finding is of little differential diagnostic significance. Once the history of antibiotic usage is elicited, endoscopic verification of pseudomembranes and documentation of elevated Clostridium difficile titres

Dr Sanjeev Mani, Bandra Holy Family Hospital, Mumbai