Bowel inflammatory presentations on computed tomography in adult patients with severe aplastic anemia during flared inflammatory episodes

Figure 1 Characteristic images of case 4. A-C: Characteristic images of the ileocecal region. The ileocecal valve (yellow arrows), the proximal ascending colon (orange arrows) and the terminal ileum (purple arrows) were significantly thickened and stratified by submucosal fat deposition, forming the so-called “fat holo sign”. From the distal ascending colon to the sigmoid colon (red arrows), the wall was thickened and stratified with “water holo sign”. The small intestine was heterogeneous in bowel wall texture, and gas-filled in some segments and liquid-filled in other segments, and a segment of adhesive bowel loop was found in the middle jejunum (blue arrows); D-F: Characteristic images of the asending colon. The irregular contour and the fibrotic thickening of the mucosal folds made the colonic configuration rugged. The mucosa of the cecum and the appendiceal root was fibrously thickened (green arrows), and the appendix was gas-filled. Thickened omentum surrounded the ileocecal region and the ascending colon. A segment of adhesive bowel loop was found in the proximal ileum (a white arrow). The mucosa of the proximal ileum in the adhered bowel loop was fibrotically thickened, with mesenteric fat deposition and adjacent peritoneal thickening forming the so-called “abdominal cocoon”; G and H: Typical fat holo sign in the ascending colon. The “fat holo sign” was more typical in the middle ascending colon; I: Thickened and stratified larger intestine. From the distal ascending colon to the sigmoid colon (red arrows), the wall was thickened and stratified by edematous submucosal tissues, forming the so-called “water holo sign”. In some segments, the colon was emptied. Paracolonic fat stranding was present from the cecum to the sigmoid colon. The disproportionately less severe paracolonic fat stranding suggested that the edematous colon most likely occurred during an acute episode.