Accordion sign

Case contributed by Elsayed Mohamed Elsayed Galbat
Diagnosis almost certain


History of recurrent duodenal cancer, presenting with increasing abdominal pain.

Patient Data

Age: 60 years
Gender: Male

Soft tissue mass lesion is seen involving the distal part of the stomach as well as adjacent duodenum infiltrating the adjacent anterior abdominal wall muscles, inseparable from the pancreatic head and adjacent hepatic parenchyma at certain points. Adjacent pathologically enlarged lymph nodes are also seen.  

Thickening, edema and enhancement are seen along the cecal wall, ascending colon and transverse colon giving classic appearance of an accordion sign indicating colitis. Normal CT appearance of superior and inferior mesenteric vessels.

The liver is studded with multiple hypodense variable sized hepatic focal lesions, likely to be metastatic.

Case Discussion

Accordion sign is a non-specific sign related to a thickened edematous large bowel wall. It can be caused by infectious colitis (like Clostridioides difficile colitis), non-specific colitis or large bowel ischemia.

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