Clostridium difficile colitis: CT findings and differential diagnosis

Radiol Med. 2019 Dec;124(12):1185-1198. doi: 10.1007/s11547-019-01066-0. Epub 2019 Jul 13.


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.

Keywords: Clostridium infections; Contrast-enhanced computed tomography; Differential diagnosis; Pseudomembranous enterocolitis.

Publication types

  • Review

MeSH terms

  • Clostridioides difficile*
  • Colitis / diagnostic imaging
  • Colon / blood supply
  • Colon / diagnostic imaging*
  • Colon / pathology
  • Colon / radiation effects
  • Contrast Media*
  • Diagnosis, Differential
  • Enterocolitis, Pseudomembranous / diagnostic imaging*
  • Graft vs Host Disease / diagnostic imaging
  • Humans
  • Ischemia / diagnostic imaging
  • Radiation Injuries / diagnostic imaging
  • Tomography, X-Ray Computed*
  • Typhlitis / diagnostic imaging


  • Contrast Media