Abdominal Imaging

, Volume 38, Issue 5, pp 994–1004 | Cite as

Acute HIV-related gastrointestinal disorders and complications in the antiretroviral era: spectrum of cross-sectional imaging findings

Pictorial Essay


Emergency physicians and radiologists are increasingly confronted with aging HIV-positive or acquired immunodeficiency syndrome (AIDS) patients with acute abdominal symptoms, who often require immediate medical or surgical treatment. A wide spectrum of infectious and neoplastic HIV-related gastrointestinal diseases may be encountered, along with atypical presentations of common disorders. Since symptoms and physical findings are commonly nonspecific or masked by concurrent illnesses, medications, and weak immune response, prompt cross-sectional diagnostic imaging studies are needed to triage patients and choose treatment. Multidetector CT currently represents the mainstay modality to promptly investigate intra-abdominal opportunistic disorders in HIV/AIDS patients, and MRI is increasingly used to assess abnormalities involving the rectum. The spectrum of cross-sectional imaging appearances of HIV-related acute gastrointestinal disorders and complications observed in the antiretroviral era is reviewed, including acute intestinal infections, causes of right lower quadrant pain, bleeding, bowel obstruction, and perforation. State-of-the-art technology, knowledge of pertinent clinical information, and familiarity with the spectrum of opportunistic diseases are necessary to improve diagnostic confidence in the detection and characterization of gastrointestinal abnormalities on urgent cross-sectional abdominal studies performed in HIV-infected patients.

Key words

Human immunodeficiency virus (HIV) Multidetector-computed tomography (MDCT) Magnetic resonance imaging (MRI) Infectious colitis Intestinal obstruction Perforation 


  1. 1.
    Carucci LR, Halvorsen RA (2004) Abdominal and pelvic CT in the HIV-positive population. Abdom Imaging 29:631–642PubMedCrossRefGoogle Scholar
  2. 2.
    Slaven EM, Lopez F, Weintraub SL, Mena JC, Mallon WK (2003) The AIDS patient with abdominal pain: a new challenge for the emergency physician. Emerg Med Clin North Am 21:987–1015PubMedCrossRefGoogle Scholar
  3. 3.
    Spencer SP, Power N, Reznek RH (2009) Multidetector computed tomography of the acute abdomen in the immunocompromised host: a pictorial review. Curr Probl Diagn Radiol 38:145–155PubMedCrossRefGoogle Scholar
  4. 4.
    Yoshida D, Caruso JM (2002) Abdominal pain in the HIV infected patient. J Emerg Med 23:111–116PubMedCrossRefGoogle Scholar
  5. 5.
    Hill A, Balkin A (2009) Risk factors for gastrointestinal adverse events in HIV treated and untreated patients. AIDS Rev 11:30–38PubMedGoogle Scholar
  6. 6.
    Kellow ZS, MacInnes M, Kurzencwyg D, et al. (2008) The role of abdominal radiography in the evaluation of the nontrauma emergency patient. Radiology 248:887–893PubMedCrossRefGoogle Scholar
  7. 7.
    Kuhlman JE, Fishman EK (1990) Acute abdomen in AIDS: CT diagnosis and triage. Radiographics 10:621–634PubMedGoogle Scholar
  8. 8.
    Hoeffel CC, Azizi L, Mourra N, et al. (2006) MRI of rectal disorders. AJR Am J Roentgenol 187:W275–W284PubMedCrossRefGoogle Scholar
  9. 9.
    Horton KM, Corl FM, Fishman EK (2000) CT evaluation of the colon: inflammatory disease. Radiographics 20:399–418PubMedGoogle Scholar
  10. 10.
    Thoeni RF, Cello JP (2006) CT imaging of colitis. Radiology 240:623–638PubMedCrossRefGoogle Scholar
  11. 11.
    Gluecker TM, Williamson EE, Fletcher JG, et al. (2003) Diseases of the cecum: a CT pictorial review. Eur Radiol 13(Suppl 6):L51–L61CrossRefGoogle Scholar
  12. 12.
    Kawamoto S, Horton KM, Fishman EK (1999) Pseudomembranous colitis: spectrum of imaging findings with clinical and pathologic correlation. Radiographics 19:887–897PubMedGoogle Scholar
  13. 13.
    Wang YC, Lee HS, Lin TY, Wang NC (2008) Cytomegalovirus colitis mimics amebic colitis in a man with AIDS. Am J Med Sci 336:362–364PubMedCrossRefGoogle Scholar
  14. 14.
    Alavi KA (2007) Amebiasis. Clin Colon Rectal Surg 20:33–37PubMedCrossRefGoogle Scholar
  15. 15.
    Gulek B, Onel S (1999) US and CT findings of rectal amebian abscess. Eur Radiol 9:719–720PubMedCrossRefGoogle Scholar
  16. 16.
    Lim JH (2008) Parasitic diseases in the abdomen: imaging findings. Abdom Imaging 33:130–132PubMedCrossRefGoogle Scholar
  17. 17.
    Pritt BS, Clark CG (2008) Amebiasis. Mayo Clin Proc 83:1154–1159 (quiz 1159–1160).Google Scholar
  18. 18.
    Guingrich JA, Kuhlman JE (1999) Colonic wall thickening in patients with cirrhosis: CT findings and clinical implications. AJR Am J Roentgenol 172:919–924PubMedCrossRefGoogle Scholar
  19. 19.
    Ormsby EL, Duffield C, Ostovar-Sirjani F, McGahan JP, Troppmann C (2007) Colonoscopy findings in end-stage liver disease patients with incidental CT colonic wall thickening. AJR Am J Roentgenol 189:1112–1117PubMedCrossRefGoogle Scholar
  20. 20.
    Restrepo CS, Diethelm L, Lemos JA, et al. (2006) Cardiovascular complications of human immunodeficiency virus infection. Radiographics 26:213–231PubMedCrossRefGoogle Scholar
  21. 21.
    Sambatakou H, Tsiachris D, Stamouli S, Gargalianos P, Archimandritis A (2008) Systemic vasculitis with gastrointestinal involvement in an HIV-infected adult. Am J Med Sci 335:237–238PubMedCrossRefGoogle Scholar
  22. 22.
    Wasnik A, Kaza RK, Al-Hawary MM, Liu PS, Platt JF (2011) Multidetector CT imaging in mesenteric ischemia–pearls and pitfalls. Emerg Radiol 18:145–156PubMedCrossRefGoogle Scholar
  23. 23.
    Savioz D, Lironi A, Zurbuchen P, et al. (1996) Acute right iliac fossa pain in acquired immunodeficiency: a comparison between patients with and without acquired immune deficiency syndrome. Br J Surg 83:644–646PubMedCrossRefGoogle Scholar
  24. 24.
    Hoeffel C, Crema MD, Belkacem A, et al. (2006) Multi-detector row CT: spectrum of diseases involving the ileocecal area. Radiographics 26:1373–1390PubMedCrossRefGoogle Scholar
  25. 25.
    Zissin R, Gayer G, Chowers M, et al. (2001) Computerized tomography findings of abdominal tuberculosis: report of 19 cases. Isr Med Assoc J 3:414–418PubMedGoogle Scholar
  26. 26.
    Collado C, Stirnemann J, Ganne N, et al. (2005) Gastrointestinal tuberculosis: 17 cases collected in 4 hospitals in the northeastern suburb of Paris. Gastroenterol Clin Biol 29:419–424PubMedCrossRefGoogle Scholar
  27. 27.
    Cappell MS, Botros N (1994) Predominantly gastrointestinal symptoms and signs in 11 consecutive AIDS patients with gastrointestinal lymphoma: a multicenter, multiyear study including 763 HIV-seropositive patients. Am J Gastroenterol 89:545–549PubMedGoogle Scholar
  28. 28.
    Khurana B, Ledbetter S, McTavish J, Wiesner W, Ros PR (2002) Bowel obstruction revealed by multidetector CT. AJR Am J Roentgenol 178:1139–1144PubMedCrossRefGoogle Scholar
  29. 29.
    Taourel P, Kessler N, Lesnik A, et al. (2002) Non-traumatic abdominal emergencies: imaging of acute intestinal obstruction. Eur Radiol 12:2151–2160PubMedGoogle Scholar
  30. 30.
    Ko CY, Schmit PJ, Petrie B, Thompson JE (1996) Abdominal tuberculosis: the surgical perspective. Am Surg 62:865–868PubMedGoogle Scholar
  31. 31.
    Greco L, Maggi P, Ialongo P, et al. (2002) Acute onset of non-Hodgkin’s lymphoma with bowel perforation in a patient with over 15 years’ HIV positivity. A case report. Chir Ital 54:893–896Google Scholar
  32. 32.
    Ghekiere O, Lesnik A, Millet I, et al. (2007) Direct visualization of perforation sites in patients with a non-traumatic free pneumoperitoneum: added diagnostic value of thin transverse slices and coronal and sagittal reformations for multi-detector CT. Eur Radiol 17:2302–2309PubMedCrossRefGoogle Scholar
  33. 33.
    Hainaux B, Agneessens E, Bertinotti R, et al. (2006) Accuracy of MDCT in predicting site of gastrointestinal tract perforation. AJR Am J Roentgenol 187:1179–1183PubMedCrossRefGoogle Scholar
  34. 34.
    Maniatis V, Chryssikopoulos H, Roussakis A, et al. (2000) Perforation of the alimentary tract: evaluation with computed tomography. Abdom Imaging 25:373–379PubMedCrossRefGoogle Scholar
  35. 35.
    Kawana M, Starr RS, Tashima KT, Treaba DO, Flanigan TP (2008) Spontaneous perforation of the terminal ileum in an AIDS patient on highly active antiretroviral therapy with disseminated non-tuberculous mycobacterial infection. Int J Infect Dis 12:603–606PubMedCrossRefGoogle Scholar
  36. 36.
    Kram HB, Shoemaker WC (1990) Intestinal perforation due to cytomegalovirus infection in patients with AIDS. Dis Colon Rectum 33:1037–1040PubMedCrossRefGoogle Scholar
  37. 37.
    Leung VK, Chu W, Lee VH, et al. (2006) Tuberculosis intestinal perforation during anti-tuberculosis treatment. Hong Kong Med J 12:313–315PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Radiology“Luigi Sacco” University HospitalMilanItaly

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