Clostridium difficile colitis: CT findings and differential diagnosis

  • Sara Guerri
  • Ginevra Danti
  • Gianluca Frezzetti
  • Edvige Lucarelli
  • Silvia PradellaEmail author
  • Vittorio Miele


Clostridium difficile infection (CDI) is a severe and potentially deadly infectious colitis whose incidence is dramatically increasing in the last decades, with more virulent strains. CDI should be suspected in case of unexplained diarrhea and abdominal pain in patients with a recent history of antibiotic use and healthcare exposures; diagnosis is based on a combination of clinical and laboratory findings with demonstration of C. difficile toxins by stool test. The advantages of contrast-enhanced computed tomography (CECT) are the noninvasiveness and the ability to evaluate both the colonic wall and the adjacent soft tissues. Considerable overlap exists between the CECT findings of CDI and those of colitis of other origins, such as typhlitis, ischemic colitis, graft-versus-host disease, radiation colitis and inflammatory bowel diseases; however, some features may help distinguish between these conditions. This paper provides a comprehensive overview of the imaging features of Clostridium difficile colitis and its mimics, with a view to assist the radiologist in reaching the correct diagnosis.


Clostridium infections Pseudomembranous enterocolitis Differential diagnosis Contrast-enhanced computed tomography 


C. difficile

Clostridium difficile


Clostridium difficile infection


Contrast-enhanced computed tomography


Graft-versus-host disease


Inflammatory bowel disease


Ischemic colitis


Non-occlusive mesenteric ischemia


American College of Gastroenterology


Crohn’s disease


Ulcerative colitis


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest related to the publication of this article.

Ethical standard

The manuscript does not contain clinical studies or patient data.


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Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  • Sara Guerri
    • 1
    • 2
  • Ginevra Danti
    • 1
  • Gianluca Frezzetti
    • 1
  • Edvige Lucarelli
    • 1
  • Silvia Pradella
    • 1
    Email author
  • Vittorio Miele
    • 1
  1. 1.Department of RadiologyAzienda Ospedaliero-Universitaria CareggiFlorenceItaly
  2. 2.Department of Experimental, Diagnostic and Specialty Medicine (DIMES)University of Bologna, S. Orsola-Malpighi HospitalBolognaItaly

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