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Typhlitis Imaging

  • Author: Thomas M Stoehr, MD; Chief Editor: Eugene C Lin, MD  more...
 
Updated: Sep 28, 2015
 

Overview

Typhlitis means inflammation of the cecum. In 1960, Bierman and Amronin first coined the term ileocecal syndrome to describe inflammation and/or necrosis of the cecum, appendix, and/or ileum in patients with leukemia.[1] Typhlitis subsequently has been associated with aplastic anemia, lymphoma, AIDS, and immunosuppression following renal transplantation or during treatment of malignancy. (See the images below.)[2, 3, 4, 5, 6]

Typhlitis. Marked low-attenuation cecal wall thickTyphlitis. Marked low-attenuation cecal wall thickening (large arrow) with moderate pericolonic inflammatory stranding (small arrows). Note thickening of transverse colon wall posteriorly.
Typhlitis. Marked asymmetric cecal wall thickeningTyphlitis. Marked asymmetric cecal wall thickening (arrow) in this 64-year-old patient whose status is postchemotherapeutic for lymphoma.

Preferred examination

Abdominal computed tomography (CT) scanning with oral and intravenous contrast is the preferred examination. The maximum normal colonic wall thickness on CT scan is 3 mm. When the colon is distended with stool, fluid, or oral contrast, the normal colonic wall is nearly imperceptible. Pericolonic fat should demonstrate homogeneous fat attenuation.

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Radiography

Plain radiographs are nonspecific but may demonstrate a fluid-filled, masslike density in the abdominal right lower quadrant (RLQ), distension of adjacent small bowel loops, and thumbprinting. Free intraperitoneal air and pneumatosis coli rarely are observed. Barium enema and colonoscopy are contraindicated in possible typhlitis because of perforation risk.

Degree of confidence

Plain radiographs may suggest abnormality but are nonspecific. Confirm abnormal findings with CT scanning.

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Computed Tomography

CT scanning demonstrates circumferential and occasionally eccentric low-attenuation colonic wall thickening and cecal distension. High attenuation within the thickened colonic wall may represent hemorrhage. Inflammatory pericolonic stranding of mesenteric fat is common. (See the images below.)[7]

Typhlitis. Marked low-attenuation cecal wall thickTyphlitis. Marked low-attenuation cecal wall thickening (large arrow) with moderate pericolonic inflammatory stranding (small arrows). Note thickening of transverse colon wall posteriorly.
Typhlitis. Marked asymmetric cecal wall thickeningTyphlitis. Marked asymmetric cecal wall thickening (arrow) in this 64-year-old patient whose status is postchemotherapeutic for lymphoma.
Typhlitis. CT of this 10-year-old patient with leuTyphlitis. CT of this 10-year-old patient with leukemia demonstrates fluid within the cecum, which has an asymmetrically thickened wall (arrows).
Typhlitis. Mild, asymmetrical, low-attenuation cecTyphlitis. Mild, asymmetrical, low-attenuation cecal wall thickening (arrow) in an 8-year-old patient with leukemia undergoing chemotherapy.
Typhlitis. Marked circumferential cecal and ascendTyphlitis. Marked circumferential cecal and ascending colon wall thickening (large arrows) with mild pericolonic inflammatory stranding (small arrows).

CT scanning readily identifies complications, including pneumatosis coli, pneumoperitoneum, pericolonic fluid collections, and abscess. These complications may require urgent surgical management.

Degree of confidence

CT scan findings consistent with typhlitis in a patient with an appropriate clinical scenario result in a high degree of confidence in the diagnosis of typhlitis.

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Ultrasonography

Ultrasonographic findings of typhlitis include absent or decreased bowel peristalsis in the RLQ, thickened hypoechoic bowel wall, and markedly thickened echogenic mucosa. Color-flow imaging reveals hypervascularity of the mucosa and bowel wall. The patient may complain of pain upon palpation with the transducer.[8, 9]

Degree of confidence

The above findings, combined with an appropriate clinical history, indicate a high probability of typhlitis. CT scanning may be indicated to exclude perforation or abscess (not visualized on ultrasonography) and to establish a baseline to compare follow-up studies.

False positives/negatives

RLQ small bowel loops distended with air can produce a significant ring-down artifact on ultrasonograms, thus obscuring visualization of the right colon.

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Contributor Information and Disclosures
Author

Thomas M Stoehr, MD 

Disclosure: Nothing to disclose.

Coauthor(s)

D Bradley Koslin, MD Professor, Department of Radiology, Oregon Health and Science University School of Medicine

D Bradley Koslin, MD is a member of the following medical societies: American College of Radiology, Association of University Radiologists, Society of Radiologists in Ultrasound, Society of Abdominal Radiology, Radiological Society of North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand

Disclosure: Nothing to disclose.

Spencer B Gay, MD Professor of Radiology, Department of Radiology and Medical Imaging, University of Virginia School of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine

Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, Society of Nuclear Medicine and Molecular Imaging

Disclosure: Nothing to disclose.

Additional Contributors

Eric P Weinberg, MD Associate Professor, Department of Radiology, University of Rochester Medical Center, Strong Memorial Hospital

Eric P Weinberg, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Radiological Society of North America

Disclosure: Nothing to disclose.

References
  1. Bierman HR, Amronin G. The ileocecal syndrome in the leukopathic conditions. Clin Res. 1960. 8:134.

  2. Haut C. Typhilitis in the pediatric patient. J Infus Nurs. 2008 Sep-Oct. 31(5):270-7. [Medline].

  3. Abu-Hilal MA, Jones JM. Typhlitis; is it just in immunocompromised patients?. Med Sci Monit. 2008 Aug. 14(8):CS67-70. [Medline].

  4. Robaday S, Kerleau JM, Tapon E, Levesque H, Marie I. [Typhlitis: report of a case and review of the literature]. Rev Med Interne. 2008 Mar. 29(3):224-7. [Medline].

  5. Altınel E, Yarali N, Isık P, Bay A, Kara A, Tunc B. Typhlitis in acute childhood leukemia. Med Princ Pract. 2012. 21 (1):36-9. [Medline].

  6. Shafey A, Ethier MC, Traubici J, Naqvi A, Sung L. Incidence, risk factors, and outcomes of enteritis, typhlitis, and colitis in children with acute leukemia. J Pediatr Hematol Oncol. 2013 Oct. 35 (7):514-7. [Medline].

  7. Frick MP, Maile CW, Crass JR. Computed tomography of neutropenic colitis. AJR Am J Roentgenol. 1984 Oct. 143(4):763-5. [Medline].

  8. Alexander JE, Williamson SL, Seibert JJ. The ultrasonographic diagnosis of typhlitis (neutropenic colitis). Pediatr Radiol. 1988. 18(3):200-4. [Medline].

  9. Glass-Royal MC, Choyke PL, Gootenberg JE. Sonography in the diagnosis of neutropenic colitis. J Ultrasound Med. 1987 Nov. 6(11):671-3. [Medline].

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Typhlitis. Marked low-attenuation cecal wall thickening (large arrow) with moderate pericolonic inflammatory stranding (small arrows). Note thickening of transverse colon wall posteriorly.
Typhlitis. Marked asymmetric cecal wall thickening (arrow) in this 64-year-old patient whose status is postchemotherapeutic for lymphoma.
Typhlitis. CT of this 10-year-old patient with leukemia demonstrates fluid within the cecum, which has an asymmetrically thickened wall (arrows).
Typhlitis. Mild, asymmetrical, low-attenuation cecal wall thickening (arrow) in an 8-year-old patient with leukemia undergoing chemotherapy.
Typhlitis. Marked circumferential cecal and ascending colon wall thickening (large arrows) with mild pericolonic inflammatory stranding (small arrows).
 
 
 
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