title: Can computed tomography aid in diagnosis of intramural hematomas of the intestinal wall?
abstract: BACKGROUND
  We sought to use computed tomography (CT) data to support the correct differential diagnosis of patients with spontaneous intramural hematomas of the gastrointestinal tract, to aid in the clinical management of those using oral anticoagulants.
  
  
  METHODS
  Patient data were retrospectively analyzed and patients were divided into two groups. The first group contained 10 patients (5 females, 5 males, median age 65 years [range 35-79 years]) who had been diagnosed with spontaneous intramural hematomas of the gastrointestinal tract. The second group contained nine patients (5 females, 4 males, median age 41 years [range 24-56 years]) who exhibited intestinal wall thickening on CT, and who had been diagnosed with ulcerative colitis, Crohn's disease, ameboma, and lymphoma. The enhancement patterns in the CT images of the two groups were compared by an experienced and inexperienced radiologist. The differences in values were subjected to ROC analysis.
  
  
  RESULTS
  Inter-observer variability was excellent (0.84) when post-contrast CT images were evaluated, as were the subtraction values (0.89). The subtracted values differed significantly between the two groups (p=0.0001). A cutoff of +31.5 HU was optimal in determining whether a hematoma was or was not present.
  
  
  CONCLUSIONS
  Contrast enhancement of an intestinal wall hematoma is less than that of other intestinal wall pathologies associated with increased wall thickness. If the post-contrast enhancement of a thickened intestinal wall is less than +31.5 HU, a wall hematoma is possible.
authors.forename: Serife
authors.initials: S
authors.lastname: Ulusan
authors.forename: Burcak
authors.initials: B
authors.lastname: Pekoz
authors.forename: Cagla
authors.initials: C
authors.lastname: Sariturk
mesh_terms: D000328:Adult; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging*; D006801:Humans; D007410:Intestinal Diseases / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult