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Evaluating the CT Diagnosis of Clostridium difficile Colitis

Should CT Guide Therapy?

Iain D. C. Kirkpatrick1 and Howard M. Greenberg

1 Both authors: Department of Radiology, University of Manitoba, Health Sciences Centre, 820 Sherbrook St., Winnipeg, Manitoba R3A 1R9, Canada.



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  		Fig. 1. —64-year-old woman with diarrhea and abdominal pain. Stool assay was positive for Clostridium difficile cytotoxin. Axial CT scan shows grossly thickened descending colon (arrow) with pericolonic stranding (solid arrowhead). Note ascites (open arrowhead) pooling in left paracolic gutter.

 


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  		Fig. 2A. —32-year-old man with abdominal pain, fever, elevated WBC count, and diarrhea. Stool assay was positive for Clostridium difficile toxin. Axial CT scan shows extensive nodular wall thickening (arrows) throughout transverse colon. Lines of high attenuation are from oral contrast material trapped between nodular bowel wall folds that produce "accordion" sign.

 


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  		Fig. 2B. —32-year-old man with abdominal pain, fever, elevated WBC count, and diarrhea. Stool assay was positive for Clostridium difficile toxin. Axial CT scan through pelvis reveals nodular thickening (arrow) within sigmoid colon.

 


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  		Fig. 3. —55-year-old man with bloody diarrhea and abdominal pain. Stool assay was negative for Clostridium difficile toxin. Note fairly symmetric wall thickening of ascending and descending colon (arrow), with only minimal pericolonic reaction (arrowhead) and no ascites. Although initial diagnosis on CT was C. difficile colitis, endoscopic biopsy showed ulcerative colitis.

 

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