Pseudomembranous colitis: diffuse involvement of the colon on radiologic imaging

Pseudomembranous colitis (PC) is typically associated with overgrowth of Clostridium difficile related to antibiotic use but may occur rarely in other clinical settings. Although the clinical and endoscopic presentation usually establishes the diagnosis, radiologic imaging is often performed in these patients and the findings may be characteristic of the disease. We describe a 44 year-old woman with squamous cell carcinoma of the cervix who had an acute onset of nausea, vomiting, diarrhea, and fever; tests were positive for Clostridium difficile. CT of the abdomen showed marked nodular thickening of the colonic wall suggesting a pancolitis. Sigmoidoscopy was performed and revealed edematous mucosa to 30 cm but no pseudomembranes or other signs of colitis; the instrument could not be passed more proximally. Contrast enema showed no focal obstruction but diffuse haustral and mucosal thickening throughout the colon consistent with PC. The patient was treated with multiple antibiotics and enteral nutrition with complete resolution of her colitis. This exhibit presents the multiple imaging findings in this patient and discusses the role of radiology in evaluating those with suspected PC.