Right-Sided Colonic Wall Thickening on Abdominal Computed Tomography as a Potential Adjunctive Imaging Clue in Thrombotic Microangiopathy Presenting With Gastrointestinal Symptoms.
- 1Department of Nephrology, Endocrinology, and Diabetes, Tokyobay Urayasu Ichikawa Medical Center, Chiba, JPN.
- 2Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, JPN.
Abstract
Thrombotic microangiopathy (TMA) presenting with gastrointestinal symptoms poses a diagnostic challenge because Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) and acquired thrombotic thrombocytopenic purpura (aTTP) share overlapping clinical features but require distinct management. We report the case of a 22-year-old woman who presented with abdominal pain and hematochezia and subsequently developed TMA. Abdominal computed tomography (CT) demonstrated continuous edematous wall thickening from the terminal ileum and cecum to the ascending colon, raising early suspicion for STEC-HUS. However, a high PLASMIC score prompted urgent empirical plasma exchange, which was unfortunately complicated by anaphylactic shock. Subsequent ADAMTS13 testing revealed preserved activity, excluding severe ADAMTS13 deficiency and strongly arguing against acute aTTP. A clinical diagnosis of probable STEC-HUS was made. To further assess the diagnostic value of CT, we reviewed eight consecutive TMA cases with gastrointestinal symptoms at our institution. Right-sided colonic wall thickening was present in all five STEC-HUS cases but absent in all three aTTP cases, each of whom demonstrated severe ADAMTS13 deficiency. These preliminary findings suggest that right hemicolon-predominant bowel wall thickening may serve as an early adjunctive imaging clue supporting the diagnosis of STEC-HUS in patients with TMA and gastrointestinal symptoms, rather than a definitive discriminator between STEC-HUS and aTTP. This index case and institutional review highlight the potential utility of abdominal CT as an adjunctive imaging clue in guiding early diagnostic reasoning in patients with TMA and gastrointestinal manifestations. Validation in larger cohorts with microbiologically confirmed STEC-HUS and ADAMTS13-confirmed aTTP is required to establish the true diagnostic performance of this finding.
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BibTeX
@article{kitamura2026rightsided,
title = {{Right-Sided Colonic Wall Thickening on Abdominal Computed Tomography as a Potential Adjunctive Imaging Clue in Thrombotic Microangiopathy Presenting With Gastrointestinal Symptoms.}},
author = {Koichi Kitamura and Koichi Hayashi and Toshihiko Suzuki},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117615},
url = {https://europepmc.org/article/MED/42999465},
note = {CC BY},
}
RIS
TY - JOUR
TI - Right-Sided Colonic Wall Thickening on Abdominal Computed Tomography as a Potential Adjunctive Imaging Clue in Thrombotic Microangiopathy Presenting With Gastrointestinal Symptoms.
AU - Koichi Kitamura
AU - Koichi Hayashi
AU - Toshihiko Suzuki
PY - 2026
DA - 2026/10/07
JO - Cureus
DO - 10.7759/cureus.117615
UR - https://europepmc.org/article/MED/42999465
AB - Thrombotic microangiopathy (TMA) presenting with gastrointestinal symptoms poses a diagnostic challenge because Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (STEC-HUS) and acquired thrombotic thrombocytopenic purpura (aTTP) share overlapping clinical features but require distinct management. We report the case of a 22-year-old woman who presented with abdominal pain and hematochezia and subsequently developed TMA. Abdominal computed tomography (CT) demonstrated continuous edematous wall thickening from the terminal ileum and cecum to the ascending colon, raising early suspicion for STEC-HUS. However, a high PLASMIC score prompted urgent empirical plasma exchange, which was unfortunately complicated by anaphylactic shock. Subsequent ADAMTS13 testing revealed preserved activity, excluding severe ADAMTS13 deficiency and strongly arguing against acute aTTP. A clinical diagnosis of probable STEC-HUS was made. To further assess the diagnostic value of CT, we reviewed eight consecutive TMA cases with gastrointestinal symptoms at our institution. Right-sided colonic wall thickening was present in all five STEC-HUS cases but absent in all three aTTP cases, each of whom demonstrated severe ADAMTS13 deficiency. These preliminary findings suggest that right hemicolon-predominant bowel wall thickening may serve as an early adjunctive imaging clue supporting the diagnosis of STEC-HUS in patients with TMA and gastrointestinal symptoms, rather than a definitive discriminator between STEC-HUS and aTTP. This index case and institutional review highlight the potential utility of abdominal CT as an adjunctive imaging clue in guiding early diagnostic reasoning in patients with TMA and gastrointestinal manifestations. Validation in larger cohorts with microbiologically confirmed STEC-HUS and ADAMTS13-confirmed aTTP is required to establish the true diagnostic performance of this finding.
SN - 2168-8184
ER -