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Imaging Diagnosis

The radiographic features of lymphogranuloma venereum have been well documented by several investigators, most notably Annamunthodo and Marryatt in their review of 144 black patients from Jamaica, 90% of whom were women. The radiographic findings on barium enema examination depend on the phase and activity of the infection. In the prestenotic phase, the rectal ampulla is narrowed and there is spasm with loss of the normal haustral and mucosal pattern. The contour of the narrowed rectum is irregular and ulcerated (Fig.20.5). There may be fistulous tracts, perirectal abscesses, and widening of the presacral space with anterior displacement of the rectosigmoid colon (Fig. 20.6). The fistulas may extend to the buttocks and occasionally upward to involve the parametrium, peritoneum, continuous or isolated segments of the colon, and rarely the small bowel.

Fig. 20.5 Lymphogranuloma venereum in a 63-year-old black man with a strongly positive Frei test and complement fixation test. There is an ulcerative proctitis with irregular contour of the rectum, deep ulcerations and thickened rectal valves, and a localized area of narrowing within 2 inches of the anus.

Fig. 20.6 LGV of the rectum with marked widening of the presacral soft tissue space. The barium-filled rectosigmoid colon (arrows) is displaced markedly anteriorly by the large retrorectal abscess, as seen on this lateral view of the pelvis.

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