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Pneumatosis cystoides coli

Roden CR - MedPix (2009)

View Article: MedPix Image - MedPix Case

Affiliation: Naval Medical Center San Diego

ABSTRACT

Diagnosis: Pneumatosis cystoides coli

History: 33 y.o. woman with a history of mediastinal B-cell lymphoma that was diagnosed six years ago. She has received chemotherapy consisting of Bleomycin, Doxyrubicin, and Cytoxin, as well as localized radiation. Her clinical course was subsequently complicated by a paralyzed right hemi diaphragm. Three years ago she was diagnosed with MAC and treated with rifabutin and clarithromycin for approx 3 years with persistent cultures after 18 months of therapy. She has also been treated with Methotrexate and Prednisone for recurrent episodes of scleritis of which an autoimmune work up has been negative. She was admitted at the beginning of August for increased cough and hemoptysis as well as bloody diarrhea. At the time of admission she also had a complaint of increased eye pain. In brief, during her admission she was evaluated by Infectious disease who made no changes to her MAC therapy medications, Ophthalmology was concerned for worsening scleritis and increased her oral steroids to 40mg qd, Cardiothoracic surgery who discussed possible resection of her damaged RUL and chronic infections, as well as Pulmonary who performed a bronchoscopy to obtain cultures as well as to localized her hemoptysis. No evidence of bleeding was noted and her cultures of the RUL have grown Aspergillus niger. Her MAC cultures are still pending at this time. She was also evaluated during this admission by GI for her diarrhea and her incidental finding of Pneumatosis cystoides coli.

Findings: Markedly abnormal appearance of the majority of the colon consistent with pneumatosis intestinalis. Multiple cystic lucencies are present diffusely within the colonic wall with sparing of the distal descending and distal transverese colon. Cystic changes are most pronounced at the hepatic and splenic flexures.

Ddx: Mucosal Disruption • Idiopathic • Trama : s/p endoscopy, surgery • Infection/inflammation: Crohn's, Ulceratice Colitis, C. difficile infection. Pulmonary Disease/Process • Bronchopleural fistula • COPD- chronic bronchitis, bullous lung disease • Asthma • Trauma- barotrauma, chest tube Increased Mucosal Permeability • s/p chemotherapy or radiation • Collagen vascular disease Other • Gas in the lumen of the bowel

Dxhow: Imaging findings with clinical correlation

No MeSH data available.


Lucency at the hepatic flexure suggestive of increased air within the bowel lumen or bowel wall.  While lung fields are not the focus of this topic, note the right upper lobe opacification consistent with cavitary lesions, consolidation and brochietasis also evident in this image and consistent with patient history.
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MPX1042_synpic50007: Lucency at the hepatic flexure suggestive of increased air within the bowel lumen or bowel wall. While lung fields are not the focus of this topic, note the right upper lobe opacification consistent with cavitary lesions, consolidation and brochietasis also evident in this image and consistent with patient history.


Pneumatosis cystoides coli

Roden CR - MedPix (2009)

Lucency at the hepatic flexure suggestive of increased air within the bowel lumen or bowel wall.  While lung fields are not the focus of this topic, note the right upper lobe opacification consistent with cavitary lesions, consolidation and brochietasis also evident in this image and consistent with patient history.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1042&req=5

MPX1042_synpic50007: Lucency at the hepatic flexure suggestive of increased air within the bowel lumen or bowel wall. While lung fields are not the focus of this topic, note the right upper lobe opacification consistent with cavitary lesions, consolidation and brochietasis also evident in this image and consistent with patient history.

View Article: MedPix Image - MedPix Case

Affiliation: Naval Medical Center San Diego

ABSTRACT

Diagnosis: Pneumatosis cystoides coli

History: 33 y.o. woman with a history of mediastinal B-cell lymphoma that was diagnosed six years ago. She has received chemotherapy consisting of Bleomycin, Doxyrubicin, and Cytoxin, as well as localized radiation. Her clinical course was subsequently complicated by a paralyzed right hemi diaphragm. Three years ago she was diagnosed with MAC and treated with rifabutin and clarithromycin for approx 3 years with persistent cultures after 18 months of therapy. She has also been treated with Methotrexate and Prednisone for recurrent episodes of scleritis of which an autoimmune work up has been negative. She was admitted at the beginning of August for increased cough and hemoptysis as well as bloody diarrhea. At the time of admission she also had a complaint of increased eye pain. In brief, during her admission she was evaluated by Infectious disease who made no changes to her MAC therapy medications, Ophthalmology was concerned for worsening scleritis and increased her oral steroids to 40mg qd, Cardiothoracic surgery who discussed possible resection of her damaged RUL and chronic infections, as well as Pulmonary who performed a bronchoscopy to obtain cultures as well as to localized her hemoptysis. No evidence of bleeding was noted and her cultures of the RUL have grown Aspergillus niger. Her MAC cultures are still pending at this time. She was also evaluated during this admission by GI for her diarrhea and her incidental finding of Pneumatosis cystoides coli.

Findings: Markedly abnormal appearance of the majority of the colon consistent with pneumatosis intestinalis. Multiple cystic lucencies are present diffusely within the colonic wall with sparing of the distal descending and distal transverese colon. Cystic changes are most pronounced at the hepatic and splenic flexures.

Ddx: Mucosal Disruption • Idiopathic • Trama : s/p endoscopy, surgery • Infection/inflammation: Crohn's, Ulceratice Colitis, C. difficile infection. Pulmonary Disease/Process • Bronchopleural fistula • COPD- chronic bronchitis, bullous lung disease • Asthma • Trauma- barotrauma, chest tube Increased Mucosal Permeability • s/p chemotherapy or radiation • Collagen vascular disease Other • Gas in the lumen of the bowel

Dxhow: Imaging findings with clinical correlation

No MeSH data available.