Right lower quadrant pain in the immunocompromised patient: CT findings in 10 cases

Ten immunosuppressed patients with right lower quadrant pain were examined by CT. Underlying conditions responsible for immunosuppression included acute myelogenous leukemia (n = 2), acute lymphocytic leukemia (n = 2), aplastic anemia (n = 2), AIDS (n = 3), and cystic fibrosis combined with prolonged steroid therapy for bronchospasm (n = 1). CT suggested the diagnosis of typhlitis (n = 7), intramural hemorrhage (n = 1), ileal perforation (n = 1), and appendiceal abscess (n = 1). The diagnosis of typhlitis was established by clinical evaluation in five patients, by colonoscopy in one patient, and by autopsy in another patient. The single cases of intestinal hemorrhage, ileal perforation, and appendiceal abscess were confirmed by exploratory laparotomy. It is difficult to make an accurate diagnosis of acute abdominal conditions in the immunosuppressed patient. Symptoms and physical findings are often suppressed as a result of steroid or immunosuppressive therapy. CT, being noninvasive, is useful in the evaluation of persistent right lower quadrant pain in the immunocompromised patient.