Transient small bowel angioedema due to intravenous iodinated contrast media

Three cases of transient proximal small bowel angioedema induced by intravenous administration of nonionic iodinated contrast media (CM) are presented.Computed tomography (CT) images in the venous phase displayed the proximal small bowel with circumferential thickening of the wall including the duodenum and proximal segment of the jejunum.The bowel wall was normal in non-enhanced images,and normal or inconspicuous in arterial phase enhanced images.In one of the three cases,the bowel wall was thickened in venous phase but disappeared in the 40 s delayed phase images.No filling defect was seen in the lumen of the superior mesenteric artery and vein.No peritoneal effusion or mesentery abnormality was found.Each of these patients reported only mild abdominal discomfort and recovered without specific treatment within a short time.Only one patient suffered mild diarrhea after scanning which had resolved by the following day.The transient anaphylactic small bowel angioedema due to intravenous iodinated contrast media was easily diagnosed based on its characteristic CT findings and clinical symptoms.Differential diagnosis may include inflammatory and ischemic bowel disease,as well as neoplasms.A three-phase CT protocol and good under-standing of this disorder are fundamentally important in the diagnosis of this condition.The supposed etiology behind the transient anaphylactic reaction to intravenous administration of iodinated CM in small bowel is similar to other CM-induced hypersensitive immediate reactions.The predilection location of transient anaphylactic bowel angioedema is the small intestine,particularly the proximal segment.A speculated cause may be the richer supply of vessels in the small intestine,ample mucous folds and loose connective tissue in the duodenum and the jejunum.

Abdominal computed tomography in refractory coeliac disease and enteropathy associated T-cell lymphoma

AIM： To evaluate computed tomography （CT） findings, useful to suggest the presence of refractory celiac disease （RCD） and enteropathy associated T cell lymphoma （EATL）. METHODS： Coeliac disease （CD） patients were divided into two groups. Group Ⅰ ： uncomplicated CD （n = 14） and RCD type Ⅰ （n = 10）. Group Ⅱ ： RCD type Ⅱ （n = 15） and EATL （n = 7）. RESULTS： Both groups showed classic signs of CD on CT. Intussusception was seen in 1 patient in group Ⅰ vs 5 in group Ⅱ （P = 0.06）. Lymphadenopathy was seen in 5 patients in group Ⅱ vs no patients in group Ⅰ （P = 0.01）. Increased number of small mesenteric vessels was noted in 20 patients in group Ⅰ vs Ⅱ in group 11 （P = 0.02）. Eleven patients （50%） in group 11 had a splenic volume 〈 122 cm^3 vs 4 in group Ⅰ （14%）, 10 patients in group Ⅰ had a splenic volume 〉 196 cm^3 （66.7%） vs 5 in group Ⅱ （33.3%） P = 0.028. CONCLUSION： CT scan is a useful tool in discriminating between CD and （Pre） EATL. RCD Ⅱ and EATL showed more bowel wall thickening, lymphadenopathy and intussusception, less increase in number of small mesenteric vessels and a smaller splenic volume compared with CD and RCD Ⅰ.