GVHD Post Show Quiz
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Which of the following organisms can be a part of the differential diagnosis of GI GVHD?
CMV
Adenovirus
H. Pylori
All of the above
CMV, adenovirus, and H. pylori should be ruled out and can present similarly on imaging.
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What is the histopathological distinctive feature of GI GVHD?
apple green birefringence
exploding crypts
home wright rosettes
signet ring cells
“Exploding crypts” are the hallmark histological finding of gastrointestinal GVHD.
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Which of the following imaging findings would be present in acute GI GVHD?
Bowel wall thickening, mucosal enhancement, diffusely affected small bowel
Bowel wall thickening, mucosal enhancement, segmentally affected small bowel
Bowel wall strictures, hepatosplenomegaly, segmentally affected small bowel
Bowel wall strictures, hepatosplenomegaly, diffusely affected small bowel
While bowel wall strictures can be found in patients with GI GVHD, this is a chronic finding rather than an acute finding. Also, small bowel affected in a segmental pattern is more common in viral disease.
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Which of the following is a hepatobiliary finding of GI GVHD?
Cholelithiasis
intraductal papillary mucinous neoplasms
liver cirrhosis
periportal edema
Cholelithiasis, IPMNs, and liver cirrhosis are not common hepatobiliary findings of GI GVHD. Other hepatobiliary findings can include hepatosplenomegaly, biliary tract thickening and enhancement, and biliary sludge.
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Which of the following is the best protocolling option for suspected GI GVHD?
CT with IV contrast
CT without IV contrast
CT with oral contrast
MRCP
MRCP can have utility for intrahepatic involvement of GI GVHD, but is not the best modality for initial suspicion. Oral contrast can obscure mucosal ulceration or mucosal hyperenhancement. No IV contrast would have minimal utility because we want to see the mucosal hyperenhancement.
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