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Graft versus host disease

Dr Michael P Hartung ◉ and Dr David Clopton et al.

Graft versus host disease (GvHD) is a frequent complication of allogeneic post hematopoietic stem cell transplantation, commonly known as bone marrow transplantation. Anti-rejection drugs have reduced the incidence, although it does still frequently occur.

Pathology

Graft versus host disease can present early/acute (<100 days) or late/chronic (>100 days) post-hematopoietic stem cell transplantation and is one of the major complications of this treatment. The skin, gastrointestinal tract (especially small bowel), and liver are the principal affected organs. Effects on the gastrointestinal tract are the most commonly described in the radiology literature.

End-organ damage is the result of recipient's immune system (mainly antigen presenting cells) interacting with donor T-cell, leading to the latter's activation with a resultant cell-mediated and inflammatory cascade ⁸. The pathophysiology of chronic GvHD is not well understood

Radiographic features

Features depend upon the organ involved.

Fluoroscopy

Gastrointestinal tract

On small bowel barium studies, the bowel is described as having a "ribbon" appearance with fold thickening. Other described features are ⁵:

edema of mucosal folds in ileum and jejunum
effacement of folds towards the ileum: can give featureless (atrophic) loops
thickening of the bowel wall
spasms and stenosis with prestenotic dilatation
in the active phase, the bowel can appear shortened

CT

Abdomen

Gastrointestinal tract

Described CT features include:

bowel wall thickening:
- considered the most consistent finding
- can affect small or large bowel or both (commonest ⁶)
bowel dilatation
mucosal enhancement
engorgement of the vasa recta adjacent to affected bowel segments ³
gastric wall thickening

Extraintestinal findings in the abdomen

Reported features include:

mesenteric stranding: ~60% ⁶
ascites
biliary abnormalities
urinary excretion of orally administered Gastrografin

Thorax

See: thoracic manifestations of graft versus host disease

References

Article information

rID: 24357

System: Gastrointestinal

Tag: cases, cases, cases

Synonyms or Alternate Spellings:

Graft-versus host disease - general
Graft versus host disease (GvHD)
GvHD

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