Pseudomembranous Colitis: Spectrum of Imaging Findings with Clinical and Pathologic Correlation1
Satomi Kawamoto, MD,
Karen M. Horton, MD and
Elliot K. Fishman, MD
1 From the Department of Radiology, Saitama Medical School, Saitama, Japan (S.K.), and The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Md (K.M.H., E.K.F.). Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received January 4, 1999; revision requested February 24 and received March 16; accepted March 19. Address reprint requests to E.K.F., Department of Radiology, Johns Hopkins Hospital, 601 N Caroline St, Baltimore, MD 21287.
View larger version (163K):
[in a new window]
|
Figure 1. Gross specimen of the resected colon from a 47-year-old woman with severe PMC that developed following antibiotic therapy shows multiple, widely distributed pseudomembranes.
|
|
View larger version (132K):
[in a new window]
|
Figure 2. Gross specimen of the resected colon from a 72-year-old man with severe PMC that developed 1 week after the patient underwent prostatectomy shows confluent pseudomembranes (straight arrows), marked submucosal edema, and mucosal ulceration (curved arrow).
|
|
View larger version (130K):
[in a new window]
|
Figure 3. Endoscopic images obtained in the same patient as in Figure 1 show characteristic yellow plaques representing pseudomembranes completely involving the visualized segments of the colon circumferentially. The images (numbered 1 through 4) were obtained in adjacent areas of the colon.
|
|
View larger version (164K):
[in a new window]
|
Figures 4-6. (4) Plain radiograph obtained in the same patient as in Figure 1 shows diffuse nodular haustral thickening and polypoid mucosal thickening (arrows). (5) Plain radiograph obtained in a 37-year-old woman with PMC shows gaseous distention of the transverse colon associated with haustral thickening (arrows). (6) Plain radiograph obtained in a 47-year-old woman with PMC shows mild to moderate haustral thickening associated with contour irregularity limited to the distal transverse and proximal descending colon (arrows). However, CT performed the same day demonstrated thickening of the entire colon (cf Fig 12).
|
|
View larger version (131K):
[in a new window]
|
Figures 4-6. (4) Plain radiograph obtained in the same patient as in Figure 1 shows diffuse nodular haustral thickening and polypoid mucosal thickening (arrows). (5) Plain radiograph obtained in a 37-year-old woman with PMC shows gaseous distention of the transverse colon associated with haustral thickening (arrows). (6) Plain radiograph obtained in a 47-year-old woman with PMC shows mild to moderate haustral thickening associated with contour irregularity limited to the distal transverse and proximal descending colon (arrows). However, CT performed the same day demonstrated thickening of the entire colon (cf Fig 12).
|
|
View larger version (143K):
[in a new window]
|
Figures 4-6. (4) Plain radiograph obtained in the same patient as in Figure 1 shows diffuse nodular haustral thickening and polypoid mucosal thickening (arrows). (5) Plain radiograph obtained in a 37-year-old woman with PMC shows gaseous distention of the transverse colon associated with haustral thickening (arrows). (6) Plain radiograph obtained in a 47-year-old woman with PMC shows mild to moderate haustral thickening associated with contour irregularity limited to the distal transverse and proximal descending colon (arrows). However, CT performed the same day demonstrated thickening of the entire colon (cf Fig 12).
|
|
View larger version (155K):
[in a new window]
|
Figures 7, 8. (7) Image from a double-contrast barium enema study of a patient with PMC demonstrates multiple nodular filling defects throughout the colon (arrows) representing pseudomembranous plaques. (8) Image from a single-contrast barium enema study of a patient with PMC demonstrates marked haustral thickening and thumbprinting of the colon, most prominently in the transverse and descending colon. The distal ileum is normal.
|
|
View larger version (142K):
[in a new window]
|
Figures 7, 8. (7) Image from a double-contrast barium enema study of a patient with PMC demonstrates multiple nodular filling defects throughout the colon (arrows) representing pseudomembranous plaques. (8) Image from a single-contrast barium enema study of a patient with PMC demonstrates marked haustral thickening and thumbprinting of the colon, most prominently in the transverse and descending colon. The distal ileum is normal.
|
|
View larger version (146K):
[in a new window]
|
Figures 9-11. CT scan obtained in a 28-year-old woman with acquired immunodeficiency syndrome who developed PMC following antibiotic therapy for pneumonia shows circumferential thickening of the edematous wall of the ascending and sigmoid colon. Note the enhancement of the luminal surface (arrowheads), a finding that indicates mucosal hyperemia. Extensive ascites is also seen. (10) CT scan obtained in a 46-year-old woman with myeloproliferative disorder who developed PMC following antibiotic therapy for pneumonia demonstrates eccentric thickening of the colon with relative sparing of the anterior wall of the transverse colon. (11a) CT scan obtained in a 39-year-old man with a history of pancreatitis with pseudocyst who developed PMC shows eccentric thickening of the transverse colon (arrow) with relative sparing of the anterior wall. (11b) CT scan shows more severe involvement of the ascending colon than of the transverse or descending colon. Note the moderate pericolonic stranding around the ascending colon.
|
|
View larger version (136K):
[in a new window]
|
Figures 9-11. CT scan obtained in a 28-year-old woman with acquired immunodeficiency syndrome who developed PMC following antibiotic therapy for pneumonia shows circumferential thickening of the edematous wall of the ascending and sigmoid colon. Note the enhancement of the luminal surface (arrowheads), a finding that indicates mucosal hyperemia. Extensive ascites is also seen. (10) CT scan obtained in a 46-year-old woman with myeloproliferative disorder who developed PMC following antibiotic therapy for pneumonia demonstrates eccentric thickening of the colon with relative sparing of the anterior wall of the transverse colon. (11a) CT scan obtained in a 39-year-old man with a history of pancreatitis with pseudocyst who developed PMC shows eccentric thickening of the transverse colon (arrow) with relative sparing of the anterior wall. (11b) CT scan shows more severe involvement of the ascending colon than of the transverse or descending colon. Note the moderate pericolonic stranding around the ascending colon.
|
|
View larger version (134K):
[in a new window]
|
Figures 9-11. CT scan obtained in a 28-year-old woman with acquired immunodeficiency syndrome who developed PMC following antibiotic therapy for pneumonia shows circumferential thickening of the edematous wall of the ascending and sigmoid colon. Note the enhancement of the luminal surface (arrowheads), a finding that indicates mucosal hyperemia. Extensive ascites is also seen. (10) CT scan obtained in a 46-year-old woman with myeloproliferative disorder who developed PMC following antibiotic therapy for pneumonia demonstrates eccentric thickening of the colon with relative sparing of the anterior wall of the transverse colon. (11a) CT scan obtained in a 39-year-old man with a history of pancreatitis with pseudocyst who developed PMC shows eccentric thickening of the transverse colon (arrow) with relative sparing of the anterior wall. (11b) CT scan shows more severe involvement of the ascending colon than of the transverse or descending colon. Note the moderate pericolonic stranding around the ascending colon.
|
|
View larger version (129K):
[in a new window]
|
Figures 9-11. CT scan obtained in a 28-year-old woman with acquired immunodeficiency syndrome who developed PMC following antibiotic therapy for pneumonia shows circumferential thickening of the edematous wall of the ascending and sigmoid colon. Note the enhancement of the luminal surface (arrowheads), a finding that indicates mucosal hyperemia. Extensive ascites is also seen. (10) CT scan obtained in a 46-year-old woman with myeloproliferative disorder who developed PMC following antibiotic therapy for pneumonia demonstrates eccentric thickening of the colon with relative sparing of the anterior wall of the transverse colon. (11a) CT scan obtained in a 39-year-old man with a history of pancreatitis with pseudocyst who developed PMC shows eccentric thickening of the transverse colon (arrow) with relative sparing of the anterior wall. (11b) CT scan shows more severe involvement of the ascending colon than of the transverse or descending colon. Note the moderate pericolonic stranding around the ascending colon.
|
|
View larger version (148K):
[in a new window]
|
Figures 12, 13. (12) Unenhanced (a) and contrast-enhanced (b) CT scans obtained in the same patient as in Figures 1 and 6 demonstrate a thickened colon wall that enhances markedly after administration of contrast material. Note the presence of ascites and diffuse subcutaneous edema. (13) CT scans obtained in a 23-year-old man with cystic fibrosis who developed PMC following antibiotic therapy for pneumonia demonstrate marked thickening of the colon wall with intense enhancement of the mucosa and thickened, low-attenuation submucosa (target sign).
|
|
View larger version (151K):
[in a new window]
|
Figures 12, 13. (12) Unenhanced (a) and contrast-enhanced (b) CT scans obtained in the same patient as in Figures 1 and 6 demonstrate a thickened colon wall that enhances markedly after administration of contrast material. Note the presence of ascites and diffuse subcutaneous edema. (13) CT scans obtained in a 23-year-old man with cystic fibrosis who developed PMC following antibiotic therapy for pneumonia demonstrate marked thickening of the colon wall with intense enhancement of the mucosa and thickened, low-attenuation submucosa (target sign).
|
|
View larger version (156K):
[in a new window]
|
Figures 12, 13. (12) Unenhanced (a) and contrast-enhanced (b) CT scans obtained in the same patient as in Figures 1 and 6 demonstrate a thickened colon wall that enhances markedly after administration of contrast material. Note the presence of ascites and diffuse subcutaneous edema. (13) CT scans obtained in a 23-year-old man with cystic fibrosis who developed PMC following antibiotic therapy for pneumonia demonstrate marked thickening of the colon wall with intense enhancement of the mucosa and thickened, low-attenuation submucosa (target sign).
|
|
View larger version (141K):
[in a new window]
|
Figures 12, 13. (12) Unenhanced (a) and contrast-enhanced (b) CT scans obtained in the same patient as in Figures 1 and 6 demonstrate a thickened colon wall that enhances markedly after administration of contrast material. Note the presence of ascites and diffuse subcutaneous edema. (13) CT scans obtained in a 23-year-old man with cystic fibrosis who developed PMC following antibiotic therapy for pneumonia demonstrate marked thickening of the colon wall with intense enhancement of the mucosa and thickened, low-attenuation submucosa (target sign).
|
|
View larger version (142K):
[in a new window]
|
Figure 14. CT scan obtained in a 34-year-old woman who developed PMC 5 weeks after undergoing heart transplantation demonstrates the accordion sign in the rectosigmoid colon. The thickened, low-attenuation colon wall indicates submucosal edema. Limited ascites is also seen.
|
|
View larger version (143K):
[in a new window]
|
Figure 15a. (a) On a CT scan obtained in a 36-year-old man with chronic renal failure who developed PMC following antibiotic therapy, the accordion sign is best appreciated in the ascending colon. (b) CT scan shows diffuse thickening of the transverse colon and descending colon.
|
|
View larger version (141K):
[in a new window]
|
Figure 15b. (a) On a CT scan obtained in a 36-year-old man with chronic renal failure who developed PMC following antibiotic therapy, the accordion sign is best appreciated in the ascending colon. (b) CT scan shows diffuse thickening of the transverse colon and descending colon.
|
|
View larger version (128K):
[in a new window]
|
Figures 16, 17. (16) CT scan obtained in a 67-year-old man who developed PMC 1 week after undergoing surgery for spine infection shows thickening of the colon wall and haustral folds limited to the rectosigmoid colon. (17) CT scan obtained in a 78-year-old woman who developed PMC following antibiotic therapy shows nodular wall thickening limited to the rectosigmoid colon (arrows).
|
|
View larger version (119K):
[in a new window]
|
Figures 16, 17. (16) CT scan obtained in a 67-year-old man who developed PMC 1 week after undergoing surgery for spine infection shows thickening of the colon wall and haustral folds limited to the rectosigmoid colon. (17) CT scan obtained in a 78-year-old woman who developed PMC following antibiotic therapy shows nodular wall thickening limited to the rectosigmoid colon (arrows).
|
|
View larger version (118K):
[in a new window]
|
Figures 18, 19. (18) CT scan obtained in a 37-year-old man with acquired immunodeficiency syndrome who developed PMC following antibiotic therapy demonstrates thickening of the ascending and proximal transverse colon with an irregular luminal surface. The distal transverse colon and the descending colon have been spared. (19) CT scan obtained in a 63-year-old man who presented with signs and symptoms of colon obstruction and had a history of sigmoid colon diverticulitis that had been treated with antibiotics shows a well-defined focal thickening of the sigmoid colon simulating colon cancer (arrows). Sigmoidectomy was performed, and pathologic findings were consistent with PMC. After sigmoid colon resection, PMC progressed to involve the entire colon, and the patient underwent partial colectomy.
|
|
View larger version (148K):
[in a new window]
|
Figures 18, 19. (18) CT scan obtained in a 37-year-old man with acquired immunodeficiency syndrome who developed PMC following antibiotic therapy demonstrates thickening of the ascending and proximal transverse colon with an irregular luminal surface. The distal transverse colon and the descending colon have been spared. (19) CT scan obtained in a 63-year-old man who presented with signs and symptoms of colon obstruction and had a history of sigmoid colon diverticulitis that had been treated with antibiotics shows a well-defined focal thickening of the sigmoid colon simulating colon cancer (arrows). Sigmoidectomy was performed, and pathologic findings were consistent with PMC. After sigmoid colon resection, PMC progressed to involve the entire colon, and the patient underwent partial colectomy.
|
|
View larger version (138K):
[in a new window]
|
Figure 20a. (a) CT scan obtained in the same patient as in Figure 2 demonstrates wall thickening and pericolonic stranding involving the entire colon. The accordion sign is seen in the ascending colon. (b) CT scan shows bilateral pleural effusions. Some thickening of the colon is seen near the splenic flexure (arrow).
|
|
View larger version (149K):
[in a new window]
|
Figure 20b. (a) CT scan obtained in the same patient as in Figure 2 demonstrates wall thickening and pericolonic stranding involving the entire colon. The accordion sign is seen in the ascending colon. (b) CT scan shows bilateral pleural effusions. Some thickening of the colon is seen near the splenic flexure (arrow).
|
|
Copyright © 1999 by the Radiological Society of North America.
