Pediatric Graft Versus Host Disease

  • Etiology: in immune suppressed patient who is status post bone marrow transplant, functionally competent introduced T-cells attack immunocompromized host cells in skin, liver, GI tract from esophagus to rectum with small bowel always involved
  • US: small and large bowel wall thickening, mainly submucosal, especially in ileocecal region, discontinuous distribution in ~ 50% helps differentiate it from typhlitis
  • CT:
    — Generalized small bowel + large bowel thickening due to inflammation and sloughing of mucosal membranes with mucosal enhancement + submucosal enhancement – halo sign, submucosal edema without perienteric stranding, prominent vasa recta (comb sign), fluid-filled dilated bowel
    — Ascites, hepatosplenomegaly, periportal edema, mucosal enhancement of gall bladder + bladder
  • Clinical: acute graft versus host disease occurs up to 30 days post bone marrow transplant, chronic graft versus host disease occurs months post bone marrow transplant, symptoms include abdominal pain / nausea / vomiting / severe secretory diarrhea, also have rash / jaundice / severe mucosal inflammation

Radiology Cases of Graft Versus Host Disease

AXR of pneumatosis intestinalis in graft versus host disease
AXR AP shows diffuse pneumatosis intestinalis of the colon from the cecum to the rectum.
Small bowel follow through of graft versus host disease
AXR AP from a small bowel follow through shows mild thickening of the small bowel folds in the distal jejunum and proximal ileum in the middle of the image.