Presentation
Abdominal pain, fever and diarrhea.
Patient Data
Appreciable circumferential mural thickening extending from the sigmoid to the cecum with associated free small to moderate intraabdominal fluid. No evidence of perforation or abscess is visualized. The small bowel is unremarkable with no evidence of stricture, obstruction or dilatation.
The aorta is non-aneurysmal. Normal enhancement of the celiac axis, SMA and IMA.
No appreciable sacral ileitis. No aggressive osseous lesions.
The spleen, kidneys and pancreas are unremarkable. The liver is normal in appearance with small likely trivial perihepatic fluid. Cholecystectomy is noted.
Bilateral consolidation of the right and left lobes is present.
Noting the clinical history of fevers, diarrhea and recent antibiotic use; in combination with appreciable radiological pancolitis, this highly suggests infectious pseudomembranous colitis. Differentials would include inflammatory bowel disease, specifically ulcerative colitis.
Ongoing colitis is visualized extending from the sigmoid to the cecum, however, a noticeable decrease in mural thickening and associated edema is appreciated. No small bowel dilation. No perforation or pneumoperitoneum.
New evolution of pleural effusions bilaterally, with the right greater than the left.
Findings suggest ongoing pancolitis with gradual radiological improvement.
Case Discussion
Pancolitis can have several diagnoses. The most common type is ulcerative colitis or pseudomembranous colitis i.e. Clostridioides difficile.
The common signs seen radiologically for Clostridioides difficile colitis include bowel wall thickening, pericolic stranding and rectal involvement. Less common signs of peritoneal free fluid (ascites) are seen in up to 40% of cases. CT as a potential diagnostic tool for Clostridioides difficile colitis has varying sensitivity - however, current literature suggests it ranges anywhere from 30-50% on average 1.
This patient had pseudomembranous colitis secondary to Clostridioides difficile (isolated and found on stool cultures).
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