CT of Gastrointestinal Complications Associated with Hematopoietic Stem Cell Transplantation
Marc Schmit1,
Wolfgang Bethge2,
Robert Beck3,
Christoph Faul2,
Claus D. Claussen1 and
Marius Horger1
1 Department of Diagnostic Radiology, Eberhard-Karls-University,
Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
2 Department of Internal Medicine II-Hematology/Oncology,
Eberhard-Karls-University, Tübingen, Germany.
3 Institute of Medical Virology, Eberhard-Karls-University, Tübingen,
Germany.
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Fig. 1A —CT shows segmental wall thickening and increased mucosal
enhancement after allogeneic hematopoietic stem cell transplantation (HSCT)
due to mucosal barrier injury. Coronal contrast-enhanced reformatted CT scan
of 27-year-old woman with acute lymphoblastic leukemia after allogeneic HSCT
shows segmental jejunal wall thickening and increased mucosal enhancement
(arrow). There was no perienteric abnormality on contrast-enhanced CT
in this patient, and symptoms resolved shortly after imaging.
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Fig. 1B —CT shows segmental wall thickening and increased mucosal
enhancement after allogeneic hematopoietic stem cell transplantation (HSCT)
due to mucosal barrier injury. CT scans show segmental wall thickening of
small bowel with alternating hypoperfused (short arrows) and
hyperperfused (long arrow, B) mural areas in 25-year-old man
with non-Hodgkin's lymphoma immediately after allogeneic HSCT. Only discrete
perienteric stranding is depicted.
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Fig. 1C —CT shows segmental wall thickening and increased mucosal
enhancement after allogeneic hematopoietic stem cell transplantation (HSCT)
due to mucosal barrier injury. CT scans show segmental wall thickening of
small bowel with alternating hypoperfused (short arrows) and
hyperperfused (long arrow, B) mural areas in 25-year-old man
with non-Hodgkin's lymphoma immediately after allogeneic HSCT. Only discrete
perienteric stranding is depicted.
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Fig. 2A —Contrast-enhanced CT scans show gastrointestinal
abnormalities in neutropenic enterocolitis. 25-year-old man with non-Hodgkin's
lymphoma after allogeneic hematopoietic stem cell transplantation (HSCT) who
presented with acute lower abdominal pain in right iliac fossa. On coronal
reformatted contrast-enhanced CT scan, typical circular wall thickening
(arrow) representing typhlitis can be identified.
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Fig. 2B —Contrast-enhanced CT scans show gastrointestinal
abnormalities in neutropenic enterocolitis. Another example of typhlitis. CT
image of 29-year-old woman with acute myeloid leukemia after allogeneic HSCT
shows increased mucosal enhancement (arrow) with insignificant
pericecal stranding. There were no other gastrointestinal abnormalities on
abdominal CT.
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Fig. 2C —Contrast-enhanced CT scans show gastrointestinal
abnormalities in neutropenic enterocolitis. Segmental cecal wall thickening
(arrow) is seen in 58-year-old woman presenting with neutropenic
colitis 2 weeks after allogeneic HSCT.
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Fig. 3A —Graft-versus-host disease (GVHD) after allogeneic
hematopoietic stem cell transplantation (HSCT). 28-year-old man with chronic
myeloid leukemia presenting after allogeneic HSCT with profuse diarrhea
related to severe acute GVHD. Note generalized small-and large-bowel wall
thickening with mucosal enhancement and submucosal edema (target sign). There
is no relevant perienteric stranding. CT scan shows segmental small-bowel
thickening with increased mucosal enhancement (arrow, A) as
well as thin-walled jejunal segments.
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Fig. 3B —Graft-versus-host disease (GVHD) after allogeneic
hematopoietic stem cell transplantation (HSCT). 28-year-old man with chronic
myeloid leukemia presenting after allogeneic HSCT with profuse diarrhea
related to severe acute GVHD. Note generalized small-and large-bowel wall
thickening with mucosal enhancement and submucosal edema (target sign). There
is no relevant perienteric stranding. CT scan shows segmental small-bowel
thickening with increased mucosal enhancement (arrow, A) as
well as thin-walled jejunal segments.
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Fig. 3C —Graft-versus-host disease (GVHD) after allogeneic
hematopoietic stem cell transplantation (HSCT). CT scan shows no abnormality
of bowel wall in 62-year-old man with histologically proven chronic
gastrointestinal GVHD after HSCT. Short arrow shows minimal large bowel
thickening and slightly increased mucosal enhancement. Long arrow points to
small bowel (jejunum) which shows no abnormalities on contrast-enhanced
CT.
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Fig. 4 —35-year-old woman treated for acute myeloid leukemia who
presented with pseudomembranous colitis after allogeneic hematopoietic stem
cell transplantation. Coronal reformatted contrast-enhanced CT scan shows
pancolonic wall thickening and mucosal enhancement. Note characteristic
haustral thickening with insinuation of contrast material between swollen
haustrae (arrow) forming accordion sign. No abnormality was noticed
along small bowel.
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Fig. 5A —CT findings of gastrointestinal CMV infection. 63-year-old
man with non-Hodgkin's lymphoma after allogeneic hematopoietic stem cell
transplantation (HSCT). CT scan shows thickening (arrow) of cecal and
jejunal mucosal folds.
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Fig. 5B —CT findings of gastrointestinal CMV infection. Unenhanced
(B) and contrast-enhanced (C) CT scans reveal focal thickening
of cecal wall in 53-year-old woman diagnosed with cytomegalovirus
enterocolitis after allogeneic HSCT for treatment of chronic myeloid leukemia.
Note sharp delineation of different wall layers (target sign, short
arrows) on unenhanced as well as contrast-enhanced CT scans. Long arrow
in C shows thickened jejunal folds in same patient with predominantly
colonic CMV infection.
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Fig. 5C —CT findings of gastrointestinal CMV infection. Unenhanced
(B) and contrast-enhanced (C) CT scans reveal focal thickening
of cecal wall in 53-year-old woman diagnosed with cytomegalovirus
enterocolitis after allogeneic HSCT for treatment of chronic myeloid leukemia.
Note sharp delineation of different wall layers (target sign, short
arrows) on unenhanced as well as contrast-enhanced CT scans. Long arrow
in C shows thickened jejunal folds in same patient with predominantly
colonic CMV infection.
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Fig. 6A —63-year-old woman after hematopoietic stem cell
transplantation (HSCT) for non-Hodgkin's lymphoma. CT scans show segmental
wall thickening with submucosal edema and strong mucosal enhancement in
terminal ileal segment (arrow, A) including cecum
(arrow, B), representing herpes simplex virus bowel infection.
Note considerable perienteric stranding and small amounts of peritoneal
fluid.
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Fig. 6B —63-year-old woman after hematopoietic stem cell
transplantation (HSCT) for non-Hodgkin's lymphoma. CT scans show segmental
wall thickening with submucosal edema and strong mucosal enhancement in
terminal ileal segment (arrow, A) including cecum
(arrow, B), representing herpes simplex virus bowel infection.
Note considerable perienteric stranding and small amounts of peritoneal
fluid.
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Fig. 7A —51-year-old man after allogeneic hematopoietic stem cell
transplantation (HSCT) for aplastic anemia. Axial contrast-enhanced CT scans
of pelvic region show segmental ileal wall thickening with sharp delineation
of different bowel wall layers (arrows) as well as strong mucosal
enhancement caused by rotavirus enteritis. Small amount of perienteric fluid
is depicted in pelvis.
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Fig. 7B —51-year-old man after allogeneic hematopoietic stem cell
transplantation (HSCT) for aplastic anemia. Axial contrast-enhanced CT scans
of pelvic region show segmental ileal wall thickening with sharp delineation
of different bowel wall layers (arrows) as well as strong mucosal
enhancement caused by rotavirus enteritis. Small amount of perienteric fluid
is depicted in pelvis.
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Fig. 8A —26-year-old man with high-grade non-Hodgkin's lymphoma who
presented with bloody diarrhea and cramplike abdominal pain caused by
adenovirus enteritis after allogeneic hematopoietic stem cell transplantation.
On unenhanced abdominal scan, there is evidence of segmental enteric wall
thickening (arrow) with increased attenuation (55 H), representing
intramural hemorrhage. Note hazy perienteric stranding.
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Fig. 8B —26-year-old man with high-grade non-Hodgkin's lymphoma who
presented with bloody diarrhea and cramplike abdominal pain caused by
adenovirus enteritis after allogeneic hematopoietic stem cell transplantation.
After IV administration of contrast medium, increased segmental enhancement is
seen at other sites along jejunum (long arrow). However, jejunal
segments with intramural hemorrhage revealed only discrete enhancement or no
enhancement (short arrow).
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Fig. 8C —26-year-old man with high-grade non-Hodgkin's lymphoma who
presented with bloody diarrhea and cramplike abdominal pain caused by
adenovirus enteritis after allogeneic hematopoietic stem cell transplantation.
Coronal reformatted CT scan shows difference in mural enhancement between
bowel segments with (small arrows) and without (long arrow)
intramural hemorrhage.
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Fig. 9A —55-year-old woman with stage III multiple myeloma. After
undergoing allogeneic stem cell transplantation, patient presented with
abdominal pain and diarrhea caused by aspergillosis. Axial contrast-enhanced
CT scans show evidence of multifocal colonic wall thickening and increased
mucosal enhancement (short arrows). Submucosal edema and discrete
pericolic stranding is also seen. Cystic masses at lower pole of left kidney
(long arrow, A) represent renal aspergillosis abscesses.
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Fig. 9B —55-year-old woman with stage III multiple myeloma. After
undergoing allogeneic stem cell transplantation, patient presented with
abdominal pain and diarrhea caused by aspergillosis. Axial contrast-enhanced
CT scans show evidence of multifocal colonic wall thickening and increased
mucosal enhancement (short arrows). Submucosal edema and discrete
pericolic stranding is also seen. Cystic masses at lower pole of left kidney
(long arrow, A) represent renal aspergillosis abscesses.
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Fig. 10 —73-year-old man after undergoing allogeneic hematopoietic
stem cell transplantation for acute myeloid leukemia. Axial contrast-enhanced
CT scan shows focal, circular colonic wall thickening with increased mucosal
enhancement (small arrow) due to candidiasis colitis. There is
minimal pericolonic stranding. Note intraluminal coproliths (large
arrow) behind involved bowel segment.
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Fig. 11A —37-year-old woman with acute lymphoblastic leukemia
presenting with cramplike abdominal pain 3 weeks after allogeneic
hematopoietic stem cell transplantation. Coronal reformatted contrast-enhanced
CT scan shows distension of small and large bowel with segmental wall
thickening (arrows). Note also minimal or even absent contrast
enhancement in colonic wall.
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Fig. 11B —37-year-old woman with acute lymphoblastic leukemia
presenting with cramplike abdominal pain 3 weeks after allogeneic
hematopoietic stem cell transplantation. There is alternation of normal
(long arrows) and decreased (short arrow) bowel wall
enhancement, suggesting colonic wall ischemia caused by vascular invasion of
Mucorales organisms.
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Fig. 12 —Coronal reformatted contrast-enhanced CT scan in 54-year-old
woman with acute myeloid leukemia in neutropenic phase after allogeneic
hematopoietic stem cell transplantation. Note segmental sigmoid wall
thickening (arrow) and pericolic stranding due to diverticulitis.
There was increased enhancement in involved bowel segment.
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Fig. 13 —53-year-old man with spontaneous colonic perforation and
pneumoretroperitoneum late after allogeneic hematopoietic stem cell
transplantation for secondary acute myeloid leukemia. Note air leakage along
right hemicolon due to small-bowel wall perforation as confirmed by surgery.
Patient presented with no abdominal symptoms. Bowel perforation was incidental
finding disclosed at chest CT, which was performed to exclude pulmonary
infection. Arrow points to extraluminal pericolonic gas accumulation due to
spontaneous bowel perforation.
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