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Título

Infectious proctitis: what the radiologist expects to find

Descrição sucinta do(s) objetivo(s)

The current research work aims to achieve the timely identification of proctitis infections and their correct differentiation from these infectious syndromes. For this purpose, 4 cases were taken as reference between May 2017 and January 2022, whose characteristic imaging findings and subsequent microbiological confirmation provided the opportunity to compile the results and use them as a reference for radiologists when guiding the diagnosis.

História clínica

Case 1: 27-year-old man diagnosed with HIV, undergoing treatment. Diarrheal stools for 2 months and perianal pain associated with pruritus. On physical examination, flat condylomas in the perianal region and anal fissure
Case 2: 35-year-old woman, history of HIV. presents mucous-bloody discharge, febrile syndrome and weight loss lasting several months. On physical examination, the sphincter was normotonic and the mucosa was congestive and bleeding, associated with generalized lymphadenopathy.
Case 3: 32-year-old man, history of HIV without adherence to ARV treatment. Mucous bloody diarrhea and weight loss. Perianal condylomas, rectal blister with bloody mucus.
Case 4: 47-year-old man with hematochezia, pruritus, and sensation of incomplete evacuation. Fistulous orifice with serous discharge in H1, to touch.

Discussão e diagnóstico

Diffuse parietal thickening is one of the main characteristics present in all our patients, highlighting the integrity of the external muscular layer and its symmetry, a finding that represents a criterion of benignity in the differential diagnosis of tumor pathology.
Trabeculation of the adjacent fatty planes, despite being a non-specific finding, was observed in most of our cases in an extensive and homogeneous manner, involving the four quadrants of the rectum and without segmentarity, a finding linked to the inflammatory process.
Possible “pitfalls” to take into account are marked parietal enhancement after the administration of intravenous contrast substance and signal restriction in diffusion sequence.

Conclusões

Clinical suspicion and microbiological analyzes are the pillars for the diagnosis of infectious proctitis. Magnetic resonance imaging findings can be very useful despite not being pathognomonic. The diffuse character and symmetrical parietal thickening have been a repeated pattern in the cases studied.

Palavras Chave

proctitis; magnetic resonance

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