RADIOLOGY: GASTROINTESTINAL: GI: Case# 32861: CMV COLITIS WITH ISCHEMIA. This is a 50 year old male who is s/p liver transplant two months ago and s/p MVA with liver laceration one month ago. He now presents with dark red blood per rectum. There is severe, nodular colonic wall thickening extending from the cecum all the way to the rectum which is more extensive proximally. A moderate amount of ascites is present throughout the abdomen and pelvis. There is a fluid loculation just inferior to the lateral segment of the left lobe of the liver. Patency of the vascular cannot be determined due to lack of intravenous contrast. Both infectious and ischemic colitis can produce the above CT findings. CMV colitis can produce colonic wall thickening. CMV colitis may also show a "target sign" due to submucosal edema. CMV infection often extends across the ileocecal valve to involve the ileum. Severe CMV colitis may result in distention and even perforation. Findings in ischemic colitis may be similar. "Thumbprinting" may be seen in the colonic wall mucosa representing heaped-up, inflamed areas of mucosa. More advanced cases of ischemic colitis result in linear or punctate collections of gas in the bowel wall. This gas may extend into the mesenteric and portal venous systems.