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Cytomegalovirus Enterocolitis in Apparently Immunocompetent Hosts: Evaluation of the Radiologic Findings and Clinical Features

Chae, Eun Young MD; Lee, Seung Soo MD; Chung, Jun-Won MD; Kim, Hyun Jin MD; Park, Seong Ho MD; Kim, Ah Young MD; Ha, Hyun Kwon MD

Journal of Computer Assisted Tomography: November/December 2010 - Volume 34 - Issue 6 - pp 892-898
doi: 10.1097/RCT.0b013e3181ecc471
Abdominal Imaging

Objective: To describe the clinical and radiologic features of cytomegalovirus (CMV) enterocolitis in apparently immunocompetent hosts.

Materials and Methods: Our institutional review board approved this retrospective study, and informed consent was waived. Twelve apparently immunocompetent patients (7 women and 5 men; mean age, 58 years) with pathologically proven CMV enterocolitis were included. Computed tomographic (CT) scans were retrospectively reviewed to determine the extent and the location of mural thickening, maximal mural thickness, enhancement pattern, that is, single-halo, double-halo, and homogeneous patterns, and ascites.

Results: Eight patients had comorbidities potentially affecting the host immune status, whereas 4 patients were apparently healthy before presentation. On CT, all patients showed mural thickening (range, 4-11 mm) involving the colon (n = 8), the small bowel (n = 1), or both (n = 3). Segmental involvement was most common (n = 9 for colon and n = 2 for small bowel), whereas focal involvement of the rectum (n = 1) and diffuse involvement of the entire ileum (n = 1) or the entire small bowel and colon (n = 1) were also noted. Colonic lesions showed variable enhancement patterns, including the single-halo (n = 6), homogeneous (n = 3), and double-halo patterns (n = 2), whereas all small-bowel lesions in 4 patients exhibited a single-ring pattern. Ascites was present in 7 patients. Complications requiring surgery occurred in 3 patients and included refractory bleeding (n = 2) and bowel perforation (n = 1).

Conclusions: Cytomegalovirus enterocolitis in immunocompetent hosts typically develops in elderly subjects with comorbidities, although it may also affect relatively young and healthy subjects. On CT, it is characterized by mild mural thickening of the small bowel and the colon and frequently shows segmental involvement and a single-halo enhancement pattern.

From the *Department of Radiology and Research Institute of Radiology, and †Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Received for publication May 4, 2010; accepted June 11, 2010.

Reprints: Seung Soo Lee, MD, Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2 dong, Songpa-ku, Seoul 138-736, Korea (e-mail: seungsoolee@amc.seoul.kr).

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