Feline eosinophilic enteritis in CT

Vet Med Sci. 2025

Toshiyuki Tanaka 1 2, Hana Tsuruta 3, Koudai Furukawa 4, Hideo Akiyoshi 5

Background:
Eosinophilic enteritis (EE) in cats is defined by the predominance of eosinophils on intestinal histopathology without identifiable underlying causes. While gastrointestinal eosinophilic sclerosing fibroplasia (GESF) represents a potential fibroblastic response in this context, imaging features of EE—particularly using computed tomography (CT)—remain underreported. This study aimed to characterize the CT features associated with EE in cats to aid in diagnosis and differentiation from other gastrointestinal conditions.

Methods:
This retrospective case series included eight cats diagnosed with EE based on histopathology following endoscopy or laparotomy. Inclusion required chronic gastrointestinal signs and histological confirmation of EE without neoplasia. All subjects underwent dual-phase contrast-enhanced CT, and images were analyzed for lesion distribution, wall layering, mass formation, lymphadenomegaly, and wall thickness. CT images were reviewed independently and in consensus by experienced radiologists.

Results:
All eight cats exhibited diffuse intestinal lesions, with 87.5% involving the duodenum, jejunum, and ileum. CT findings revealed thickening of the outer intestinal wall in all cats, with a layered wall appearance in 87.5% (early phase) and 62.5% (delayed phase). One cat presented with a mass formation, and 50% had lymphadenomegaly, often with a rounded shape. The mean wall thickness exceeded normal reference values in all cats. Two cats also showed ascites, potentially indicating serosal involvement. Lymph node enlargement was both regional and non-regional.

Limitations:
The study lacked histopathological confirmation for all CT-detected lesions and did not incorporate ultrasonographic comparisons. The small sample size limits generalizability, and absence of peripheral eosinophilia or visceral eosinophil infiltration data precludes a complete understanding of systemic involvement.

Conclusions:
In cats with EE, CT imaging commonly shows thickening of the outer intestinal layer with a layered appearance and rounded lymphadenomegaly. These features may help distinguish EE from other inflammatory gastrointestinal diseases. However, further research is needed to establish diagnostic specificity and elucidate the relationship between EE and GESF.

Representative computed tomography (CT) images of eosinophilic enteritis (EE) in pre-contrast (A), early-phase post-contrast (B), delayed-phase post-contrast (C) and reformatted plane (D). EE showed thickening of outer intestinal layer with development of a layered wall appearance and rounded lymphadenomegaly. In one cat, the mass formed (arrowhead) in the outer layer of the jejunal EE region (E). Mucosal layer (arrow), outer intestinal layer (*), enlarged lymph node (**).

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