Small-Bowel Mucormycosis at Dual-Energy CT.

Abstract

HomeRadiologyVol. 307, No. 5 PreviousNext Reviews and CommentaryFree AccessImages in RadiologySmall-Bowel Mucormycosis at Dual-Energy CTLoic Demir, Paul Calame Loic Demir, Paul Calame Author AffiliationsFrom the Department of Radiology (L.D., P.C.) and EA 4662 Nanomedicine Laboratory, Imagery and Therapeutics (P.C.), University of Bourgogne Franche-Comté, CHRU Besançon, 3 boulevard Alexandre Fleming, 25030 Besançon, France.Address correspondence to P.C. (email: [email protected]).Loic DemirPaul Calame Published Online:Jun 20 2023https://doi.org/10.1148/radiol.223271MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Supplemental material is available for this article.A 22-year-old woman with acute myeloid leukemia was treated with allograft and immunosuppressants. Five days later, she developed abdominal pain and underwent CT of the abdomen, which showed isolated small-bowel wall thickening with normal enhancement. A second CT examination was performed 3 days later due to worsening febrile abdominal pain; this examination showed diffuse small-bowel wall thickening. Dual-energy CT images showed focal defects of the normal small-bowel mucosal enhancement suggestive of nonperforated necrotizing infectious enterocolitis (Figure, Movie). She underwent small-bowel resection. Pathologic analysis of resected samples showed focal areas of transmural necrosis due to multiple vascular mycotic thrombi (Figure).Images in a 22-year-old female patient with a primary history of allograft-treated acute myeloid leukemia complicated by mucormycotic ulcerative-necrotic enterocolitis. (A) Conventional and (B) iodine density images in the same axial section of the portal phase of abdominal CT. The dual-energy CT images show dilatated small bowel (★) associated with a lack of wall enhancement (arrowhead), which contrasts with the adjacent hyperenhanced mucosa (arrow). (C) A photograph of the gross small-bowel resection specimen shows focal ileal ischemic ulceration (arrowheads).Download as PowerPointOpen in Image Viewer Get the Flash Player to see this video.Movie: Movie file of iodine density merged with virtual noncontrast in axial CT sections. The scale shows iodine concentration in milligrams of iodine per milliliter. A = anterior, F = front, L = left, P = posterior, R = right.Download Original Video (19.0 MB)Mucormycosis is caused by fungi of the subphylum mucoromycotina, which are zygomycetes that invade vessels, causing thrombosis and eventually parenchymal necrosis. Small-bowel mucormycosis is the least common site; mortality is high (1). Mucormycosis may mimic ischemic bowel (2,3). Dual-energy CT improved bowel wall visualization and highlighted the defects in the mucosa readily, which expedited surgical management—a key prognostic point (1).Disclosures of conflicts of interest: L.D. No relevant relationships. P.C. No relevant relationships.