Gastrointestinal ImagingColitis, pseudomembranous
a form of colitis, which is usually associated with the administration of antibiotics. Pseudomembranous colitis (PMC) is caused by the cytotoxin produced by a Gram-positive bacillus:
Clostridium difficile. Pathologically the common characteristic of PMC is the presence of coalescing pseudomembranes composed of epithelial debris,
fibrin and mucus in the large bowel. After sloughing large areas of
mucosa are denuded.
On plain abdominal radiography the main findings are thumbprinting and change in the normal haustral pattern of the colon. On barium enema, the borders of the colon appear shaggy and irregular due to the incomplete adherence of the barium to the mucosa, which is covered with the pseudomembranes (Fig.1). CT displays the marked thickening of the colonic wall and of the interhaustral folds which may lead to marked luminal reduction. The borders of the colon appear unsharp because of the pericolic inflammation which is revealed as streaky and strand-like linear and reticular infiltration.
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Barium enema demonstrates extremely unsharp serosal lining, irregular contours and marked narrowing of the lumen of the right hemicolon. Note also the thickening of the interhaustral folds on the transverse colon.
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Colitis, pseudomembranous, Fig.1 | |