Pseudomembranous colitis: diagnostic sensitivity of the abdominal plain radiograph
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1Department of Radiology, Massachusetts General Hospital, Boston 02114.
Abstract:
We performed a retrospective study to determine the incidence of plain radiographic abnormalities in patients with pseudomembranous colitis (PMC). One hundred and fifty-two plain radiographs of the abdomen (taken within 3 days of pseudomembranous colitis diagnosis) from 152 patients with pseudomembranous colitis were reviewed. Forty-eight of 152 (32%) plain radiographs were abnormal, demonstrating: colonic ileus in 48/152 (32%), small bowel ileus in 31/152 (20%), ascites in 10/152 (7%), and nodular haustral thickening in 28/152 (18%). The distribution in 48 patients with colonic ileus included: right colon, 41/48 (86%), transverse colon, 35/48 (72%), and left colon, 26/48 (55%). Distribution in 28 patients with nodular haustral thickening included: right colon, 5/28 (18%), transverse colon, 15/28 (54%), and left colon, 14/28 (50%). Radiographic changes were non-specific in 32% of patients with changes more specific to PMC in only 18%.
Insights
Plain abdominal X-rays reveal abnormalities in 32% of pseudomembranous colitis (PMC) patients. Findings like colonic ileus were common, but often non-specific for diagnosing PMC.
Area of Science:
- Radiology
- Gastroenterology
- Internal Medicine
Background:
- Pseudomembranous colitis (PMC) is a serious condition often diagnosed via colonoscopy.
- Plain abdominal radiography is frequently used in evaluating patients with suspected abdominal pathology.
Purpose of the Study:
- To determine the incidence and characteristics of plain abdominal radiographic abnormalities in patients diagnosed with pseudomembranous colitis (PMC).
Main Methods:
- A retrospective review of 152 abdominal plain radiographs from 152 patients diagnosed with PMC within 3 days of imaging.
- Analysis of radiographic findings including colonic ileus, small bowel ileus, ascites, and nodular haustral thickening.
- Assessment of the distribution of abnormalities within the colon and the specificity of findings for PMC.
Main Results:
- Abnormalities were present in 32% (48/152) of the radiographs.
- Colonic ileus (32%) was the most frequent abnormality, followed by small bowel ileus (20%), nodular haustral thickening (18%), and ascites (7%).
- Radiographic changes were non-specific in 32% of patients, with only 18% showing findings more specific to PMC.
Conclusions:
- Plain abdominal radiography demonstrates abnormalities in a significant minority of patients with pseudomembranous colitis (PMC).
- The observed radiographic findings, such as colonic ileus, are often non-specific, limiting their utility as a primary diagnostic tool for PMC.
- While not definitive, radiographic abnormalities can provide supportive evidence or indicate complications in the management of PMC.