DOI:10.2214/AJR.07.2628
AJR 2008; 190:712-719
© American Roentgen Ray Society
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.
Received May 25, 2007;
accepted after revision September 26, 2007.
Address correspondence to M. Horger
(mshorger{at}med.uni-tuebingen.de).
Abstract
OBJECTIVE. This article illustrates the characteristic CT findings
of bowel damage related to drug toxicity, conditioning regimen, infections,
and graft-versus-host disease (GVHD) in patients after hematopoietic stem cell
transplantation.
CONCLUSION. Although some overlap exists in the CT appearances of
the different causes of bowel wall inflammation, the findings are frequently
unique enough to suggest a specific diagnosis. Awareness of the specific time
of occurrence, intensity of clinical symptoms, preferred localization, and
extent of accompanying extraintestinal findings help to distinguish the
different pathologic entities.
Keywords: gastrointestinal complications • hematopoietic stem cell transplantation
Introduction
Allogeneic hematopoietic stem cell transplantation (HSCT), either from
matched related or matched unrelated donors, provides a potential cure for a
variety of hematologic (e.g., acute and chronic myeloid leukemia,
myelodysplastic syndrome, acute lymphoblastic leukemia, multiple myeloma,
non-Hodgkin's lymphoma, Hodgkin's disease) and nonhematologic diseases.
Although treatment-related morbidity associated with allogeneic HSCT has
decreased over the past decade, complications due to drug toxicity, infectious
agents, and graft-versus-host disease (GVHD) remain major obstacles for the
success of allogeneic HSCT. Allogeneic trans plant recipients are at risk for
developing GVHD, contrary to autologous and syngeneic transplant recipients,
who are less likely to have chronic or late posttransplantation complications.
Also, nonmyeloablative transplant recipients are less prone to develop
opportunistic infections and other complications during the period immediately
after transplantation, but they are at risk for developing chronic GVHD and
other chronic complications. The increasing use of this treatment modality
mandates that the radiologist be familiar with these potential complications.
Besides neurologic, pulmonary, and hepatosplenic complications,
gastrointestinal complications are associated with a high morbidity and
mortality rate.
Drug-Related and Conditioning Regimen–Associated Bowel Damage
Mucositis is an inevitable side effect of high-dose conditioning regimens
used for conventional HSCT. The condition is better referred to as
"mucosal barrier injury" because it is the result of toxicity and
represents a complex and dynamic pathobiologic process with manifestations
throughout the entire digestive tract
[1]. Mucosal barrier injury
consists of four phases—namely, inflammatory, epithelial, ulcerative,
and healing phases. The inflammatory phase is characterized by the induction
of proinflammatory cyto kines inter-leukin-1, tumor necrosis factor 
,
and interferon-
by cytotoxic drugs and irradiation while the epithelial
cells are still intact. These cytokines induce major changes in functionality,
permeability, mucosal cell metabolism, and mucosal cell integrity
[1]. During the epithelial
phase, rapidly proliferating mucosal cells are inhibited in their renewal,
leading to mucosal atrophy, thinning, and necrosis. This process culminates in
the ulcerative phase within approximately 14 days of starting chemotherapy
[1]. The healing phase
parallels hematologic reconstitution (Fig.
1A).
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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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CT findings in mucosal barrier injury include bowel wall thickening,
mucosal hyper-emia, or even mosaic perfusion (Figs.
1B and
1C) with segmental or diffuse
gastrointestinal tract involvement. Perienteric stranding, ascites, and lymph
node enlargement are generally moderate. The gastrointestinal tract is usually
involved in a diffuse manner, generating mild clinical symptoms, such as
secretory diarrhea or abdominal pain.
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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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Neutropenic Colitis (Typhlitis or Cecitis)
Typhlitis or neutropenic enterocolitis may be considered as the paradigm
for mucosal barrier injury because its pathogenesis requires a simultaneous
profound neutropenia and a disturbed resident microflora
[1]. It is characterized by
edema and inflammation of the cecum and ascending colon, sometimes also
involving the terminal ileum
[2–5]
(Figs. 2A,
2B,
2C). The hemorrhagic necrosis
seen in neutropenic enterocolitis may be considered as part of the spectrum of
ischemic bowel disease, from which it cannot be distinguished without
additional clinical and laboratory information
[3]. CT images typically show
cecal wall thickening with hyperemia and moderate inflammatory stranding
[4–7].
There is usually little ascites and no regional lymph node enlargement.
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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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Graft-Versus-Host Disease
The immunologic recovery after allogeneic HSCT is divided into three
phases: In the preengraftment phase, which typically lasts 10–30 days,
the immune system is severely compromised by pancytopenia
[8]. Host defense barriers may
be further weakened by mucositis and other chemotherapy-related complications
[1,
8]. In the early
posttrans-plantation phase, which typically spans the period from 30 to 100
days after transplantation, profound neutropenia has resolved but lymphocyte
recovery lags, resulting in continued deficiency of cellular and humoral
immunity with frequent infectious complications
[8]. Acute GVHD can develop as
soon as engraftment is immanent
[8] and usually manifests as
secretory diarrhea, sometimes with mild to moderate abdominal pain.
The most consistent CT finding is abnormal mucosal enhancement of the
entire gastrointestinal tract with emphasis on the small intestine
[6,
7,
9]. This finding corresponds
histopathologically to a denuded mucosa, which is replaced by a layer of
highly vascularized granulation tissue
[9]
(Fig. 3A). Other frequent CT
findings in acute gastrointestinal GVHD include fluid-filled and dilated bowel
loops (luminal diameter > 3 cm), the comb sign, bowel fold thickening,
submucosal edema, and bowel loop separation
(Fig. 3B). Although mucosal
enhancement is always diffusely contiguous, bowel wall thickening is often
limited to the small bowel. Perienteric stranding is an uncommon finding
[9].
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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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Prophylactic immunosuppressive therapy with cyclosporine and methotrexate,
cyclosporine alone, or cyclosporine with prednisone has led to a significant
reduction in the incidence of acute GVHD, with improved survival. In the late
posttransplantation phase, which begins 100 days after transplantation,
chronic GVHD of the gastrointestinal tract is expected, which generally shows
few or no abnormalities at imaging
[10]
(Fig. 3C). Malabsorption is the
predominant clinical manifestation resulting from persistent impaired mucosal
immunity.
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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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Infectious Enterocolitis
Pseudomembranous Colitis
The broad-spectrum antimicrobial therapy administered during the
preengraftment phase may lead to an imbalance of the residential intestinal
flora with overgrowth with Clostridium difficile organisms and
related toxin production. This toxin severely damages the mucosal surface of
the colon, resulting in profuse watery diarrhea with abdominal pain and
fever.
The most common CT finding is diffuse colonic involvement with marked
eccentric or circumferential wall thickening, which usually exceeds the wall
thickening seen in other types of colitis
[5]. The insinuation of
contrast material between the pseudomembranes and swollen plicae semilunaris
coli form the accordion sign, which is highly suggestive of the diagnosis
[5]
(Fig. 4). Because the disease
predominantly involves the mucosa and submucosa, the degree of pericolonic fat
stranding is disproportionately smaller than the marked colonic wall
thickening. Generally, the whole large bowel is affected, but early
manifestation can present with segmental bowel wall thickening.
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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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Viral Infections
Viral infections are a common cause of bowel inflammation after allogeneic
HSCT; the most common viral pathogens include cytomegalovirus (CMV),
adenovirus (ADV), herpes simplex virus (HSV), rotavirus, and astrovirus.
During the early posttransplantation period (31–100 days after
transplantation), CMV infection is the leading cause of gastrointestinal
infectious complications, such as diarrhea, hemorrhage, perforation, and
peritonitis. CMV colitis characteristically manifests as cecal wall thickening
with contiguous involvement of the terminal ileum and ascending colon. Mucosal
ulcerations are frequent and may appear round or serpiginous.
CT findings in gastrointestinal CMV infection are similar to those in
typhlitis with an extensive target sign that can be depicted even on
unenhanced CT scans [11]
(Fig. 5A). Perienteric fluid
and stranding are more obvious in patients with gastrointestinal CMV infection
than in patients with typhlitis (Fig.
5B). Accompanying small-bowel wall thickening might furthermore be
present (Fig. 5C). Similar CT
findings can be found in HSV infection (10–30 days after
transplantation) of the gastrointestinal tract
(Fig. 6A); however,
small-bowel involvement is usually segmental with perienteric stranding
[12]
(Fig. 6B). Segmental enteritis
with strong mucosal enhancement, moderate perienteric stranding, and
intraluminal fluid accumulation is also found in rotavirus enteritis (Figs.
7A and
7B). ADV enteritis
(30–100 days after transplantation) often results in bowel wall
hemorrhage, with hyperattenuating mural blood clots depicted on unenhanced CT
[13]
(Fig. 8A). After IV contrast
material administration, hemorrhagic thickened bowel walls may show only
minimal enhancement, mimicking ischemia (Figs.
8B and
8C).
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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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Fungi
Fungi typically cause infections in patients with severe (< 100
neutrophils/µl2) and prolonged (> 2 weeks) neutropenia.
Candidiasis, Aspergillus, and Mucorales organisms are the most
frequently identified. In Aspergillus colitis, there is a marked
tendency of the fungus to invade blood vessels and cause vascular occlusion
with peripheral areas of hemorrhage and areas of secondary infarction.
Aspergillosis is frequently systemic in neutropenic patients
(Fig. 9A), but it may also
present as localized infection of the gastrointestinal tract
[14]
(Fig. 9B). Invasive
candidiasis and mucormycosis have a similar pathogenesis
(Fig. 10).
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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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Mucormycosis is less common than candidiasis, but it is recognized
increasingly because of more rigorous antifungal prophylaxis and resulting
selection of Mucorales organisms. When the gastrointestinal tract is involved,
the esophagus and the stomach are the most common sites of involvement.
Intestinal mucormycosis seems to have a predilection for the terminal ileum
and cecum [15]. The disease
usually has a fulminant and rapidly fatal course, therefore necessitating
prompt diagnosis and aggressive treatment. Contrast-enhanced CT findings show
diffuse circumferential wall thickening with areas of both intense and poor
contrast enhancement, where the poorly enhancing areas coincide with areas of
necrosis and infarction, whereas the enhancing areas represent edema and
inflammation in the submucosa and muscular layers
[15] (Figs.
11A and
11B).
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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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Others
Rare gastrointestinal complications encountered in the late phase after
allogeneic HSCT comprise pneumatosis cystoides intestinalis, which harbors
severe ischemia, infection and inflammation in preexisting diverticulosis
(Fig. 12), and spontaneous
bowel perforation (Fig.
13).
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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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Conclusion
Although some overlap exists in the CT appearances of the different causes
of bowel wall inflammation, the location of the involved bowel segments,
extent of involvement, and the presence and intensity of accompanying findings
such as mesenterial stranding or ascites may help in narrowing the
differential diagnosis. Furthermore, an awareness of the clinical setting in
which the disorder occurs (e.g., time point after HSCT, type of HSCT, start
and intensity of conditioning regimen) and information concerning ongoing
antimicrobial therapy or prophylaxis, laboratory data, and stool specimens are
crucial to suggest a specific diagnosis.
References
- Blijlevens NMA, Donnelly JP, De Pauw BE. Mucosal barrier injury:
biology, pathology, clinical counterparts and consequences of intensive
treatment for haematological malignancy—an overview. Bone
Marrow Transplant 2000; 25:1269
–1278[CrossRef][Medline]
- Wagner ML, Rosenberg HS, Fernbach DJ, Singleton EB. Typhlitis: a
complication of leukemia in childhood. AJR1970; 109:341
–350[Abstract]
- Sternberg SS, Carter D, Oberman HA, Mills SE, Stoler MH.
Sternberg's diagnostic surgical pathology, 4th ed.,
vol. 2 New York, NY: Lippincott Williams & Wilkins,2004
: 1510–1511
- Kirkpatrick ID, Greenberg HM. Gastrointestinal complications in the
neutropenic patient: characterization and differentiation with abdominal CT.
Radiology 2003;226
: 668–674[Abstract/Free Full Text]
- Horton KM, Corl FM, Fishman EK. CT evaluation of the colon:
inflammatory disease. Radio-Graphics2000; 20:399
–418[Abstract/Free Full Text]
- Benya EC, Sivit CJ, Quinones RR. Abdominal complications after bone
marrow transplantation in children: sonographic and CT findings.
AJR 1993; 161:1023
–1027[Abstract/Free Full Text]
- Levine DS, Navarro OM, Chaudry G, Doyle JJ, Blaser SI. Imaging the
complications of bone marrow transplantation in children.
RadioGraphics 2007;27
: 307–324[Abstract/Free Full Text]
- Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL.
Harrison's principles of internal medicine, 16th ed.
New York, NY: McGraw Hill Medical Publishing Division, 2004:668
–673
- Donnelly LF, Morris CL. Acute graft-vs.-host disease in children:
abdominal CT findings. Radiology 1996;198
: 1–9[Free Full Text]
- Coy DL, Ormazabal A, Godwin JL, Lalani T. Imaging evaluation of
pulmonary and abdominal complications following hematopoietic stem cell
transplantation. RadioGraphics 2005;25
: 305–317; discussion
318[Abstract/Free Full Text]
- Teixidor HA, Honig CL, Norsoph W, et al. Cytomegalovirus infection
of the alimentary canal: radiologic findings with pathologic correlation.
Radiology 1987;163
: 317–323[Abstract/Free Full Text]
- Kingreen D, Nitsche A, Beyer J, Siegert W. Herpes simplex infection
of the jejunum occurring in the early post-transplantation period.
Bone Marrow Transplant 1997;20
: 989–991[CrossRef][Medline]
- Symeonidis N, Jakubowski A, Pierre-Louis S, et al. Invasive
adenoviral infections in T-cell-depleted allogeneic hematopoietic stem cell
transplantation: high mortality in the era of cidofovir. Transpl
Infect Dis 2007; 9:108
–113[CrossRef][Medline]
- Mohite U, Kell J, Haj MA, et al. Invasive aspergillosis localised
to the colon presenting as toxic megacolon. Eur J
Haematol 2007; 78:270
–273[CrossRef][Medline]
- Lee JH, Ha HK, Yoo E, Yang SK, Min YI, Auh YH. CT and
sonographically guided biopsy in a patient with intestinal mucormycosis.
AJR 2000; 175:129
–131[Free Full Text]
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Abstract
Introduction
