Abdominal computed tomography in refractory coeliac disease and enteropathy associated T-cell lymphoma

AIM: To evaluate computed tomography (CT) findings, useful to suggest the presence of refractory celiac disease (RCD) and enteropathy associated T cell lymphoma (EATL).

METHODS: Coeliac disease (CD) patients were divided into two groups. Group I: uncomplicated CD (n = 14) and RCD type I (n = 10). Group II: RCD type II (n = 15) and EATL (n = 7).

RESULTS: Both groups showed classic signs of CD on CT. Intussusception was seen in 1 patient in group I vs 5 in group II (P = 0.06). Lymphadenopathy was seen in 5 patients in group II vs no patients in group I (P = 0.01). Increased number of small mesenteric vessels was noted in 20 patients in group I vs 11 in group II (P = 0.02). Eleven patients (50%) in group II had a splenic volume < 122 cm3 vs 4 in group I (14%), 10 patients in group I had a splenic volume > 196 cm3 (66.7%) vs 5 in group II (33.3%) P = 0.028.

CONCLUSION: CT scan is a useful tool in discriminating between CD and (Pre) EATL. RCD II and EATL showed more bowel wall thickening, lymphadenopathy and intussusception, less increase in number of small mesenteric vessels and a smaller splenic volume compared with CD and RCD I.