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Fulminant Enterocolitis in Wegener's Granulomatosis

CT Findings with Pathologic Correlation

Perry J. Pickhardt1,2,3 and Valentine W. Curran3

1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
2 Department of Radiology, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814.
3 Department of Radiology, National Naval Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889-5600.



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  		Fig. 1A. —26-year-old man with recently diagnosed Wegener's granulomatosis who developed abdominal pain and diarrhea. CT scan with oral contrast material shows normal-appearing small and large bowels without wall thickening or mesenteric soft-tissue stranding. Assessment is some-what limited by lack of IV contrast material and poorly opacified small bowel.

 


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  		Fig. 1B. —26-year-old man with recently diagnosed Wegener's granulomatosis who developed abdominal pain and diarrhea. CT scan with lung window setting shows multifocal air—space consolidation.

 


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  		Fig. 1C. —26-year-old man with recently diagnosed Wegener's granulomatosis who developed abdominal pain and diarrhea. IV contrast-enhanced CT scans obtained several days after A and B show prominent wall thickening of duodenum (arrowheads, C), jejunum (straight arrows, D), and colon (curved arrows, D) with mucosal and serosal enhancement separated by low-attenuation mural edema. Extensive mesenteric inflammatory changes are present. Note rapid interval change between A and D, which were obtained at similar level.

 


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  		Fig. 1D. —26-year-old man with recently diagnosed Wegener's granulomatosis who developed abdominal pain and diarrhea. IV contrast-enhanced CT scans obtained several days after A and B show prominent wall thickening of duodenum (arrowheads, C), jejunum (straight arrows, D), and colon (curved arrows, D) with mucosal and serosal enhancement separated by low-attenuation mural edema. Extensive mesenteric inflammatory changes are present. Note rapid interval change between A and D, which were obtained at similar level.

 


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  		Fig. 1E. —26-year-old man with recently diagnosed Wegener's granulomatosis who developed abdominal pain and diarrhea. Photograph of resected gross specimen shows diffuse bowel wall thickening and area of hemorrhagic necrosis (arrows).

 

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