Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2023; 11(3): 576-597
Published online Jan 26, 2023. doi: 10.12998/wjcc.v11.i3.576
Bowel inflammatory presentations on computed tomography in adult patients with severe aplastic anemia during flared inflammatory episodes
Xi-Chen Zhao, Cheng-Jiang Xue, Hui Song, Bin-Han Gao, Fu-Shen Han, Shu-Xin Xiao
Xi-Chen Zhao, Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
Cheng-Jiang Xue, Department of Neurosurgery, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
Hui Song, Bin-Han Gao, Department of Radiology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
Fu-Shen Han, Department of Pneumology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China
Shu-Xin Xiao, Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
Author contributions: Zhao XC and Xiao SX developed the idea; Zhao XC and Xue CJ organized the study; Zhao XC, Xue CJ, Song H, Gao BH, Han FS, and Xiao SX reviewed and consulted the CT images; Zhao XC drafted the manuscript; Xiao SX revised and approved the final manuscript; all authors have read and approved the final version of the manuscript.
Supported by the Specialized Scientific Research Fund Projects of the Medical Group of Qingdao University, No. YLJT20201002.
Institutional review board statement: The study was reviewed and approved by the Central Hospital of Qingdao West Coast New Area Institutional Review Board (Approval No. 2022-10-08).
Informed consent statement: The requirement of written informed consent was waived by The Ethics Committee of The Central Hospital of Qingdao West Coast New Area since this was a retrospective study and no information linked to the patients’ identity was revealed in the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to declare that are relevant to the content of this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shu-Xin Xiao, MD, Chief Physician, Department of Hematology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266000, Shandong Province, China. xsxa@sina.com
Received: October 19, 2022
Peer-review started: October 19, 2022
First decision: November 25, 2022
Revised: December 3, 2022
Accepted: January 5, 2023
Article in press: January 5, 2023
Published online: January 26, 2023
Processing time: 99 Days and 0.8 Hours
Abstract
BACKGROUND

Patients with severe aplastic anemia (SAA) frequently present with inflammatory episodes, and during flared inflammatory episodes, hematopoietic function is further exacerbated. The gastrointestinal tract is the most common site for infectious and inflammatory diseases, and its structural and functional features confer on it the most potent capacity to affect hematopoietic and immune functions. Computed tomography (CT) is a readily accessible approach to provide highly useful information in detecting morphological changes and guiding further work-ups.

AIM

To explore CT imaging presentations of gut inflammatory damage in adult SAA patients during inflammatory episodes.

METHODS

We retrospectively evaluated the abdominal CT imaging presentations of 17 hospitalized adult patients with SAA in search of the inflammatory niche when they presented with systemic inflammatory stress and exacerbated hematopoietic function. In this descriptive manuscript, the characteristic images that suggested the presence of gastrointestinal inflammatory damage and related imaging presentations of individual patients were enumerated, analyzed and described.

RESULTS

All eligible patients with SAA had CT imaging abnormalities that suggested the presence of an impaired intestinal barrier and increased epithelial permeability. The inflammatory damages were concurrently present in the small intestine, the ileocecal region and the large intestines. Some readily identified imaging signs, such as bowel wall thickening with mural stratification (“water holo sign”, “fat holo sign”, intramural gas and subserosal pneumatosis) and mesenteric fat proliferation (fat stranding and “creeping fat sign”), fibrotic bowel wall thickening, “balloon sign”, rugged colonic configuration, heterogeneity in the bowel wall texture, and adhered and clustered small bowel loop (including various patterns of “abdominal cocoon”), occurred at a high incidence, which suggested that the damaged gastrointestinal tract is a common inflammatory niche responsible for the systemic inflammatory stresses and the exacerbated hematopoietic failure in patients with SAA. Particularly, the “fat holo sign” was present in 7 patients, a rugged colonic configuration was present in 10 patients, the adhesive bowel loop was present in 15 patients, and extraintestinal manifestations suggestive of tuberculosis infections were present in 5 patients. According to the imaging features, a suggestive diagnosis of Crohn’s disease was made in 5 patients, ulcerative colitis in 1 patient, chronic periappendiceal abscess in 1 patient, and tuberculosis infection in 5 patients. Other patients were diagnosed with chronic enteroclolitis with acutely aggravated inflammatory damage.

CONCLUSION

Patients with SAA had CT imaging patterns that suggested the presence of active chronic inflammatory conditions and aggravated inflammatory damage during flared inflammatory episodes.

Keywords: Aplastic anemia; Computed tomography; Bowel inflammatory damage; Fat holo sign; Balloon sign; Abdominal cocoon

Core Tip: Patients with severe aplastic anemia frequently present with inflammatory episodes. The gastrointestinal tract is the most common site for infectious and inflammatory diseases, and its structural and functional features confer on it the most potent capacity to affect hematopoietic and immune functions. We retrospectively reviewed the bowel morphological changes on computed tomography in seventeen patients with severe aplastic anemia during flared inflammatory episodes. All patients demonstrated imaging abnormalities that suggested the presence of active chronic inflammatory conditions and aggravated inflammatory damage in the gastrointestinal tract. These inflammatory conditions likely contributed to their systemic inflammatory stresses and exacerbated hematopoietic failure.