CT findings and differential diagnosis of pseudomembranous colitis

doi:10.3877/cma.j.issn.2095-2015.2024.02.014

Abstract

Abstract:

Clostridium difficile is the primary pathogenic bacterium associated with pseudomembranous colitis (PMC). During an imbalance in the gut microbiota, Clostridium difficile proliferates and releases a large amount of toxins, leading to PMC. Diagnosis can be confirmed based on recent antibiotic use, diarrhea, and detection of Clostridium difficile pathogens or toxins. CT can assist in evaluating the extent and severity of the lesions. The CT manifestations of PMC overlap to some extent with other causes of colitis, but certain imaging features can help differentiate these conditions. This article provides a comprehensive review of the imaging features and differential diagnosis of PMC.

Key words: Clostridium difficile, Pseudomembranous colitis, Computed tomography

Zhaonan Sun, Jiangkai He, Wenpeng Huang, Xiaoyu Hu, Yong Huang, Xiaoying Wang. CT findings and differential diagnosis of pseudomembranous colitis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(02): 172-176.

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References 36

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影像学表现	伪膜性结肠炎	肠结核	其他病原体感染性的结肠炎	移植物抗宿主病	中性粒细胞减少性小肠结肠炎	缺血性结肠炎	克罗恩病	溃疡性结肠炎
肠壁增厚程度	明显，结节样水肿	对称性增厚	不同程度增厚	轻度增厚，厚度>7 mm可除外	轻度增厚	取决于发病机制和疾病阶段	偏心，节段性	环周增厚，病变连续
病变累及范围	全结肠炎，约30%-40%局限于升结肠	回盲部多见	因病原体而异	范围较小，分布不连续，小肠可受累	盲肠，也可累及升结肠、回肠末端	闭塞型肠系膜缺血按闭塞的血管供血区分布，左伴结肠多见	胃肠道任何部位，跳跃性分布	始于直肠，向近端延续
肠壁增强模式	靶征，手风琴征	明显	均匀强化	黏膜明显强化	靶征	取决于发病机制和疾病阶段	靶征	靶征
肠外表现	腹水程度轻，与明显增厚的肠壁不匹配	坏死性淋巴结	产生液体增多，结肠内积液、气液平面	肠系膜渗出	肠系膜渗出	血管内充盈缺损，腹盆腔脏器梗死，肠系膜渗出积液	肠系膜脂肪增殖，瘘	直肠周围脂肪增殖

影像学表现	伪膜性结肠炎	肠结核	其他病原体感染性的结肠炎	移植物抗宿主病	中性粒细胞减少性小肠结肠炎	缺血性结肠炎	克罗恩病	溃疡性结肠炎
肠壁增厚程度	明显，结节样水肿	对称性增厚	不同程度增厚	轻度增厚，厚度>7 mm可除外	轻度增厚	取决于发病机制和疾病阶段	偏心，节段性	环周增厚，病变连续
病变累及范围	全结肠炎，约30%-40%局限于升结肠	回盲部多见	因病原体而异	范围较小，分布不连续，小肠可受累	盲肠，也可累及升结肠、回肠末端	闭塞型肠系膜缺血按闭塞的血管供血区分布，左伴结肠多见	胃肠道任何部位，跳跃性分布	始于直肠，向近端延续
肠壁增强模式	靶征，手风琴征	明显	均匀强化	黏膜明显强化	靶征	取决于发病机制和疾病阶段	靶征	靶征
肠外表现	腹水程度轻，与明显增厚的肠壁不匹配	坏死性淋巴结	产生液体增多，结肠内积液、气液平面	肠系膜渗出	肠系膜渗出	血管内充盈缺损，腹盆腔脏器梗死，肠系膜渗出积液	肠系膜脂肪增殖，瘘	直肠周围脂肪增殖

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