Presentation
Acute abdominal pain, diarrhea and vomiting. Febrile with low blood pressure (septic shock). Past history is notable for a recent course of antibiotics for a sore throat.
Patient Data
The colon, along its entire length, has moderate edematous mural thickening, thumbprinting (haustral thickening), and a shaggy, hyperenhancing mucosal outline consistent with the 'accordion sign' associated with C. difficile colitis. The rectum is also involved.
Moderate amount of simple peritoneal free fluid within all four quadrants and within the sigmoid mesentery. No abdominal collection or large bowel dilatation. No free peritoneal gas.
11 mm simple cyst in segment 8 of the liver. 4 mm lesion in segment 4a abuts the capsule but is too small to be accurately characterized on CT, probably benign.
Urinary catheter balloon is in an appropriate position within the neck of the bladder. Small uterine fibroid and mural calcification in pelvic organs are otherwise unremarkable.
Diffuse subcutaneous edema throughout the abdomen and pelvis (anasarca).
Bilateral pleural effusions with associated atelectasis (right greater than left). No pleural enhancement.
Case Discussion
This case is a good demonstration of the 'accordion' or 'concertina' sign of C. difficile colitis (the diagnosis was confirmed by fecal samples being positive for C. difficile toxin).