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Pseudomembranous colitis: CT findings in children
J G Blickman1, G W Boland, R H Cleveland
1Massachusetts General Hospital, Boston, Massachusetts, USA.
Insights
Computed tomography (CT) findings in children with pseudomembranous colitis (PMC) may suggest the diagnosis. However, CT is less specific than clinical and laboratory findings for identifying pediatric PMC.
Area of Science:
- Radiology
- Pediatric Gastroenterology
- Infectious Diseases
Background:
- Pseudomembranous colitis (PMC) in adults is characterized by specific CT findings like nodular haustral thickening and accordion patterns.
- The occurrence of these CT findings in pediatric PMC is not well-established.
Purpose of the Study:
- To evaluate the spectrum of CT findings in children diagnosed with pseudomembranous colitis (PMC).
- To correlate CT findings with clinical outcomes in pediatric PMC.
Main Methods:
- Retrospective review of CT scans from nine pediatric patients with PMC.
- CT scans were performed within 3 days of a positive Clostridium difficile toxin assay.
- Analysis of CT abnormalities including colonic wall thickening, nodular haustral thickening, accordion pattern, ascites, and pericolonic edema.
Main Results:
- Colonic wall thickening was observed in 78% of patients (mean 14.5 mm).
- Nodular haustral thickening occurred in 44% and the accordion pattern in 22% of patients.
- Pericolonic edema was present in 33% and ascites in 11%.
Conclusions:
- CT findings in pediatric PMC can be suggestive but are less specific than clinical and laboratory data.
- CT may aid in diagnosing PMC in children, but definitive diagnosis relies on other methods.
Abstract:
A spectrum of nodular haustral thickening and an accordion pattern have been reported as specific features of pseudomembranous colitis (PMC) in adults. A retrospective review of nine patients with PMC was performed to assess whether this spectrum of CT findings also occurred in children. In four girls and five boys, CT scans were performed within 3 days of a positive stool toxin assay for Clostridium difficile. Documented CT abnormalities included nodular haustral thickening, the accordion pattern, colonic wall thickening, ascites, and pericolonic edema. These results were then correlated as to their impact on the clinical outcome. Circumferential colon wall thickening was identified in 7/9 (78 %) patients (mean thickening 14.5 mm). Nodular haustral thickening was identified in 4/9 (44 %) and the accordion pattern in 2/9 (22 %). Other findings included pericolonic edema in 3/9 (33 %) and ascites in 1/9 (11 %). Wall thickening was confined to the left colon and rectum in 2/9 (22 %), to the right colon in 2/9 (22 %), and involved the whole colon in 3/9 (33 %). Although CT findings associated with PMC in children may be suggestive for this diagnosis, CT is less specific than laboratory and clinical findings.