Differential Diagnosis for Colitis
The patient's symptoms of liquid fecal contents throughout the colon and diffuse mural hyperenhancement of the colon concerning for colitis can be approached by considering the following differential diagnoses:
Single most likely diagnosis
- Inflammatory Bowel Disease (IBD), specifically Ulcerative Colitis: This is the most likely diagnosis given the diffuse involvement of the colon and the presence of liquid fecal contents, which are common findings in ulcerative colitis. The diffuse mural hyperenhancement is also consistent with active inflammation.
Other Likely diagnoses
- Infectious Colitis: This could be due to bacterial, viral, or parasitic infections. The presence of liquid fecal contents and diffuse mural hyperenhancement could be seen in severe infections such as Clostridioides difficile colitis.
- Pseudomembranous Colitis: Typically caused by Clostridioides difficile, this condition can present with similar imaging findings, including diffuse colonic involvement and mural hyperenhancement.
- Ischemic Colitis: Although less likely given the diffuse nature of the findings, ischemic colitis can cause mural hyperenhancement and should be considered, especially if there are risk factors for ischemia.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Toxic Megacolon: A life-threatening complication of colitis that requires prompt recognition and treatment. It is characterized by significant colonic dilatation and can be seen in the setting of severe colitis.
- Neutropenic Colitis (Typhlitis): This condition occurs in neutropenic patients and can present with similar imaging findings. It is a medical emergency due to the high risk of perforation and sepsis.
Rare diagnoses
- Eosinophilic Colitis: A rare condition characterized by eosinophilic infiltration of the colonic wall, which can cause symptoms and imaging findings similar to other forms of colitis.
- Allergic Colitis: More commonly seen in infants but can occur in adults, typically in the setting of food allergies or other allergic reactions.
- Collagenous Colitis: A type of microscopic colitis that can present with chronic watery diarrhea and may show subtle changes on imaging, including mural hyperenhancement in some cases.