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

Figure 2 Characteristic images of case 3. A-C: Characteristic images of the thickened transverse colon. The segmentally thickened, stratified (water holo sign) and emptied colon with paracolonic fat stranding was present in the hepatic flexure (yellow arrows) in which an inflamed polypoid lesion was found on endoscopic examination, followed by the asymmetrically thickened wall and gas-filled lumen of the transverse colon (red arrows) in which the colonic villi were absent; D-F: Characteristic images of the thickened descending colon. The wall of the descending and sigmoid colon was thickened and stratified with mesenteric fat stranding (orange arrows), with the most striking segment being in the splenic flexure; G and H: Characteristic images of an adhesive bowel loop. While the ileum was gas-filled and distended (green arrows), the adhesive jejunal loop (white arrows) was heterogeneous in bowel wall texture and liquid-filled with multiple gas-liquid levels and accrescent plica. Increased mesenteric fat and vasculature were adjacent to the adhered jejunal loop; I: Characteristic image of a balloon sign. Clustering and hypervascular mesenteric fat proliferation wrapped a segment of paper-thin ileum, forming the so-called “balloon sign”. Balloon sign was also present in the hepatic flexure.