Typhlitis Imaging

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

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 thick 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 Typhlitis. 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 thick 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 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 leu 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 cec Typhlitis. Mild, asymmetrical, low-attenuation cecal wall thickening (arrow) in an 8-year-old patient with leukemia undergoing chemotherapy.
Typhlitis. Marked circumferential cecal and ascend Typhlitis. 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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