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Pseudomembranous colitis in renal transplant recipients; plain film findings
Abstract:
The plain abdominal film findings in nine renal transplant patients with pseudomembranous colitis were characteristic of but not specific for this entity and most commonly showed "thumb-printing" reflecting submucosal edema (five patients) and a persisting localized segmental ileus in the colon (five patients). Based on the plain film findings, the differential diagnosis will include the acute stages of ulcerative colitis, granulomatous colitis, ischemic colitis and other inflammatory colitides, but the radiologist is in a position to suggest the correct diagnosis in the appropriate clinical setting. A barium study of the colon is not indicated, as diagnosis is usually accomplished by endoscopy. The etiology of this colitis has recently been shown to be a cytopathic toxin of the anaerobic bacterium, Clostridium difficile.
Insights
Plain abdominal X-rays in renal transplant patients with pseudomembranous colitis show characteristic "thumb-printing" and ileus. While not specific, these findings aid radiologists in suggesting the correct diagnosis in clinical context.
Area of Science:
- Radiology
- Gastroenterology
- Nephrology
Background:
- Pseudomembranous colitis can occur in renal transplant patients.
- Plain abdominal films are often the initial imaging modality used.
Purpose of the Study:
- To describe the plain abdominal film findings in renal transplant patients diagnosed with pseudomembranous colitis.
- To evaluate the utility of plain films in diagnosing this condition.
Main Methods:
- Retrospective review of plain abdominal films from nine renal transplant patients with pseudomembranous colitis.
- Analysis of characteristic radiographic findings.
Main Results:
- "Thumb-printing" (submucosal edema) and localized segmental ileus were the most common findings.
- These findings are characteristic but not specific for pseudomembranous colitis.
Conclusions:
- Plain abdominal films can suggest pseudomembranous colitis in renal transplant patients.
- Radiologists can propose the correct diagnosis when correlated with clinical information.
- Endoscopy is typically required for definitive diagnosis; barium studies are not indicated.