Imaging of Abdominal Complications Associated With Hematopoietic Stem Cell Transplantation  Paraskevi A. Vlachou, MBChB, Martin E. O'Malley, MD  Canadian Association of Radiologists Journal  Volume 65, Issue 1, Pages 35-41 (February 2014) DOI: 10.1016/j.carj.2012.11.001 Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 1 Computed tomography and endoscopic findings in a 50-year-old man with intestinal graft-versus-host disease 40 days after allogeneic bone marrow transplantation for B-cell chronic lymphocytic leukaemia. (A) Contrast-enhanced computed tomography, showing marked mucosal and serosal enhancement, with submucosal oedema affecting the ileal loops (arrows), which results in the “target” sign. (B) Endoscopy, showing diffuse mucosal erythema. This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2014 65, 35-41DOI: (10.1016/j.carj.2012.11.001) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 2 A 49-year-old woman with steroid-resistant graft-versus-host disease 5 months after allogeneic bone marrow transplantation. (A, B) Coronal contrast-enhanced computed tomography, showing bowel-wall thickening, with intense mucosal enhancement that involves the stomach (A, short arrow), small and large (A, long arrow) bowel, including the rectum (B, arrow). Note the minimal or absent perienteric abnormality. (C) Abnormal mucosal enhancement also are noted in the urinary bladder (arrows). Canadian Association of Radiologists Journal 2014 65, 35-41DOI: (10.1016/j.carj.2012.11.001) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 3 Colonic biopsy from a patient with graft-versus-host disease (GVHD), revealing destruction of mucosa with surface ulceration and crypt destruction. Degenerating (arrow) and regenerative (interrupted arrow) crypts are also noted. H&E stain (original magnification ×2). This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2014 65, 35-41DOI: (10.1016/j.carj.2012.11.001) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 4 A 51-year-old woman treated with bone marrow transplantation for acute myeloid leukaemia. After conditioning therapy while in isolation, she developed Clostridium difficile colitis. Despite treatment, her clinical condition worsened, which necessitated colectomy. Coronal contrast-enhanced computed tomography, showing striking oedema of the colonic wall, with trapping of oral contrast between thickened folds, giving an “accordion” appearance (arrows). There is ascites but minimal pericolonic stranding. Canadian Association of Radiologists Journal 2014 65, 35-41DOI: (10.1016/j.carj.2012.11.001) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 5 A 50-year-old woman with cytomegalovirus colitis after allogeneic bone marrow transplantation for acute myeloid leukaemia. (A, B) Contrast-enhanced computed tomography, showing diffuse thickening of the colon and rectum. Note considerable pericolonic stranding and a small amount of free fluid. Canadian Association of Radiologists Journal 2014 65, 35-41DOI: (10.1016/j.carj.2012.11.001) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 6 A 63-year-old man with neutropenic enterocolitis after hematopoietic stem cell transplantation for non-Hodgkin lymphoma. (A) Contrast-enhanced computed tomography, showing marked circumferential mural thickening confined to the cecum and (B) terminal ileum (arrow). Canadian Association of Radiologists Journal 2014 65, 35-41DOI: (10.1016/j.carj.2012.11.001) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 7 A 55-year-old man 3 months after allogeneic bone marrow transplantation for non-Hodgkin lymphoma presented with diarrhoea. The patient was on high-dose steroids for graft-versus-host disease. (A, B) Contrast-enhanced computed tomography, showing extensive pneumatosis intestinalis affecting the colon, with free retroperitoneal air (B, arrow). He improved with conservative treatment. Canadian Association of Radiologists Journal 2014 65, 35-41DOI: (10.1016/j.carj.2012.11.001) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 8 A 54-year-old man with graft-versus-host disease (GVHD) and benign pneumatosis intestinalis. The patient developed diarrhoea and melena 4 months after allogeneic bone marrow transplantation for acute myeloid leukemia. (A) Contrast-enhanced computed tomography, showing intramural air in the colon, which improved with conservative treatment and antibiotics. (B) Eight days later, note the increased mucosal enhancement and wall thickening that involves the gallbladder and the small and large bowel (arrows), in keeping with GVHD. Canadian Association of Radiologists Journal 2014 65, 35-41DOI: (10.1016/j.carj.2012.11.001) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 9 A 54-year-old man with hepatic veno-occlusive disease after unrelated allogeneic bone marrow transplantation (BMT) treatment for myelofibrosis. (A, B) Normal Doppler sonogram appearances before BMT. (C, D) One month after BMT, there is interval narrowing of hepatic veins and the development of ascites. This figure is available in colour online at http://carjonline.org/. Canadian Association of Radiologists Journal 2014 65, 35-41DOI: (10.1016/j.carj.2012.11.001) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 10 Hepatosplenic fungal infection. (A) A 37-year-old man with graft-versus-host disease (GVHD) and hepatosplenic candidiasis after hematopoietic stem cell transplantation. Contrast-enhanced computed tomography, showing multiple small ring-enhancing “target” lesions in the liver and spleen (arrow). (B) A 56-year-old man with GVHD after allogeneic bone marrow transplantation for aplastic anemia. Gadolinium-enhanced T1W magnetic resonance image during the portal venous phase, showing hepatic fungal macroabscess proven by biopsy. Canadian Association of Radiologists Journal 2014 65, 35-41DOI: (10.1016/j.carj.2012.11.001) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 11 A 42-year-old woman with vaginal stenosis 1 year after hematopoietic stem cell transplantation for diffuse large B-cell lymphoma, who presented with amenorrhea for several months. Ultrasound, showing hematocolpometra (arrow) secondary to vaginal stenosis. Canadian Association of Radiologists Journal 2014 65, 35-41DOI: (10.1016/j.carj.2012.11.001) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 12 A 54-year-old woman with graft-versus-host disease (GVHD) and hemorrhagic cystitis 3 months after allogeneic bone marrow transplantation for T-cell prolymphocytic leukaemia. (A) Transverse ultrasound, showing marked thickening of the urinary bladder wall, which is small volume, likely due to spasm. (B) The same patient 3 months earlier, contrast-enhanced computed tomography, showing normal urinary bladder and GVHD of small and large bowel (arrow). Canadian Association of Radiologists Journal 2014 65, 35-41DOI: (10.1016/j.carj.2012.11.001) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions

Figure 13 A 37-year-old man with isolated extramedullary relapses. The patient underwent auto- and allogeneic bone marrow transplantation for diffuse large B-cell lymphoma 4 years earlier. Computed tomography, showing a large soft-tissue mass within the left renal sinus that extends into the anterior perinephric space. Open biopsy confirmed the diagnosis of granulocytic sarcoma. Canadian Association of Radiologists Journal 2014 65, 35-41DOI: (10.1016/j.carj.2012.11.001) Copyright © 2014 Canadian Association of Radiologists Terms and Conditions