Presentation
Patient with B cell acute lymphoblastic leukemia on hyper-CVAD chemotherapy regimen. Neutropaenic (0.0 x 10^9/L). Presents with new per rectum bleeding and diarrhea.
Patient Data
There is wall thickening as well as diffuse intramural hypodensity affecting the cecum, ascending, transverse and the majority of the descending colon. The appendix is also inflamed and measures up to 9 mm. The terminal ileum is spared and has a normal appearance. The remainder of the large bowel and rectum are unremarkable. Note is made of relative medial positioning of the descending colon. This abnormal colonic bowel wall thickening is associated with surrounding colonic fat stranding, most pronounced adjacent to the cecum. There is also thickening of the parietal peritoneum adjacent to the cecum and ascending colon. Mesenteric venous congestion is noted. Moderate volume free intraperitoneal fluid pools predominantly within the pelvis. No enlarged mesenteric or para-aortic lymph nodes.
The liver, gallbladder, adrenal glands, pancreas and spleen have an unremarkable appearance. 15 mm hypodensity within the lower pole right kidney. Multiple right-sided renal cysts are again noted. Left kidney is unremarkable.
The imaged lung bases are clear. No suspicious osseous lesion.
Case Discussion
Neutropaenic colitis or typhlitis typically involves the cecum as in this case. Intramural hypodensity represents either edema or hemorrhage.