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

Figure 13  Characteristic images of case 14. A-C: Characteristic images of the bowel inflammatory lesions. The ileocecal valve and the ileal wall were fibrotically thickened and the ileal lumen was gas-filled (yellow arrows), with a large cluster of hypervascular perienteric fat proliferation wrapping the wall-thickened and lumen-dilated ileum. The cecum (blue arrows) and appendix (green arrows) were also fibrotically thickened and stratified, with peripheral fat stranding. Gas-liquid levels were present in the lumen of the proximal ileum and distal jejunum (purple arrows). However, the adhesive jejunal loop was liquid-filled with prominent hypervascular mesenteric fat proliferation. In a segment of the jejunum (white arrows), the bowel wall was thickened, the lumen was gas-filled and the mesenteric fat stranding was especially prominent. Thickened peritoneum was adjacent to the adhesive jejunal loop, forming the so-call “abdominal cocoon” and the enlarged mesenteric vascularity formed the so-called “comb sign”. The ascending colon was dilated with a paper-thin bowel wall (black arrows), forming the so-called “balloon sign”. From the hepatic flexure to the distal descending colon (red arrows), the bowel was thickened and stratified (water holo sign), with paracolonic fat stranding and peritoneal thickening being particular prominent in the hepatic flexure. The sigmoid colon was fibrotically thickened and dilated (orange arrows); D and E: Characteristic images in coronally reconstructed images. The coronally reconstructed images better outlined the above-mentioned imaging features; F: Characteristic image of the descending colon in coronally reconstructed section. A coronally reconstructed image better outlined the thickened and stratified descending colon.