case_images: PMC11751233_01
case_images: Chest computed tomography images. (A, B) The patient's chest CT scans on the first day after admission. (C, D) A chest computed tomography image was obtained on hospital day 13. (E, F) A chest computed tomography image was obtained on hospital day 23.
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case_images: F1
case_images: CT examination of the chest revealed: scattered patchy hyperdense and solid shadows in the upper lobe in both lungs, but predominantly in the right lung (Figures 1A, B). Chest CT examination indicated that there are inflammatory manifestations in both lower lobes of the lungs (Figures 1C, D). After 10 days of fluid therapy, a chest computed tomography image showed that the lung lesions are resolved (Figures 1E, F), and the patient experienced worsening abdominal distension, and another abdominal CT showed increased thickening and edema of the bowel wall, with the thickest portion measuring ~0.9 cm and increased wall density (CT value of 57.7 HU, suggestive bowel necrosis, Figures 3B, C). Upon reexamination, multiple laboratory test indicators tended to be normal (Supplementary Figure 1).
case_images: Chest X-ray imaging. (A) A chest X-ray imaging was obtained on hospital day 2. (B) A chest X-ray imaging was obtained on hospital day 8. (C) A chest X-ray imaging was obtained on hospital day 12.
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case_images: F2
case_images: Two days later, Chest X-ray imaging indicates inflammatory changes in both lungs (Figure 2A). The reexamination of the chest plain film showed a progressive improvement compared with the previous one (Figures 2B, C).
case_images: Abdominal computed tomography images. (A) On the 13th day after admission, the distal jejunal wall was thickened, edema was visible in the mesentery, the fat space was blurred, and the thickness of the tube wall was about 0.5 cm, and the contrast scan showed obvious enhancement. (B, C) On the 23rd day after admission, the intestinal wall is thickened and edematous, with a maximum thickness of about 0.9 cm, the density of the tube wall is increased, multiple free air shadows (suggesting perforation) can be seen in the adjacent fat space, and the mesangium and omentum are thickened.
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case_images: F3
case_images: The wall thickness was ~0.5 cm, with significant enhancement on the contrast-enhanced scan (CT value of 24 HU), lower than the normal bowel wall enhancement (Figure 3A). After 10 days of fluid therapy, a chest computed tomography image showed that the lung lesions are resolved (Figures 1E, F), and the patient experienced worsening abdominal distension, and another abdominal CT showed increased thickening and edema of the bowel wall, with the thickest portion measuring ~0.9 cm and increased wall density (CT value of 57.7 HU, suggestive bowel necrosis, Figures 3B, C).
case_images: Photograph taken during surgery. (A) The right hemicolectomy (red arrowhead), surrounded by inflammatory thickened tissue. (B) Multiple perforations and necrosis of part of the ileum and right companion colon.
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case_images: F4
case_images: The diagnosis was confirmed as multiple ischemic necrosis and perforations of the ileum and ascending colon (Figure 4).