CT imaging features of eosinophilic colitis in children

Abstract

Background: Eosinophilic colitis (EC) is a gastrointestinal disease of undetermined etiology whose clinical features overlap with those of the inflammatory bowel diseases. To the best of our knowledge, the CT imaging features of EC have not been described in children.

Objective: To report and analyze the clinical, imaging and histological findings in seven children with EC.

Materials and methods: Children with EC were identified in a pediatric pathology database, and those with CT imaging within 2 months of diagnosis were included, totaling seven children. Clinical, imaging and pathological features were reviewed and analyzed.

Results: The most common presenting symptoms were abdominal pain, bloody diarrhea and rectal bleeding. EC was characterized as a dense and predominantly eosinophilic inflammatory infiltrate in the lamina propria or epithelium without granulomas. CT scans were abnormal in six children (86%), demonstrating colonic wall thickening, predominantly cecal, in five (71%), mild to moderate terminal ileal thickening in two (29%), and pneumatosis in one (14%). Right colonic involvement was greater than terminal ileal involvement.

Conclusion: CT imaging findings in children with EC include right colonic wall thickening of variable extent downstream and absent or mild involvement of the terminal ileum. EC should be considered in the differential diagnosis in children presenting with abdominal pain and bloody diarrhea.

Fig. 1

Histological examination. H&E-stained sections (a low power, × 200; b high power, × 400) show eosinophilic infiltration of the lamina propria with associated crypt abscess (aarrow)

Fig. 2

Patient 1 (16-year-old girl). Coronal CT image shows focal mild haustral thickening (arrow) in the cecal wall

Fig. 3

Patient 5 (10-year-old boy). a Sagittal CT image shows moderate cecal wall thickening (black arrow) and mild terminal ileal wall thickening (white arrow). b Coronal CT image shows cecal wall thickening greater than descending colonic wall thickening (black arrow) and a small amount of infrahepatic ascites (white arrow)

Fig. 4

Patient 6 (13-year-old boy). a Oblique coronal CT image shows moderate ascending colonic wall thickening with luminal contrast (black arrow) and featureless descending colonic wall thickening without luminal contrast (white arrow). b Oblique axial CT image shows mild transverse colonic wall thickening (black arrow)

Fig. 5

Patient 4 (2-year-old boy). a Axial CT image shows rectosigmoid pneumatosis (arrows), wall thickening and ascites. b Coronal CT image shows cecal, sigmoid and descending colonic wall thickening (arrows)