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Case contributed by Vikas Shah
Diagnosis almost certain


1 week of diarrhea and fever.

Patient Data

Age: 40 years
Gender: Female

Abdominal x-ray


"Thumbprinting" of the transverse colon wall is present - this is a radiographic sign of colon wall edema. The colon is not dilated.

CT abdomen and pelvis


The entire colon is thick walled with increased enhancement of the wall. There is a small volume of free fluid outside of the colon with fat stranding and congested vasculature. The lumen contains fluid but no solid feces. The small bowel is normal. Normal appearances elsewhere.

Case Discussion

Causes of pancolitis include ulcerative colitis, pseudomembranous colitis, and other infective colitides.

Despite the apparently severe findings on CT, endoscopy revealed only mild inflammation with no signs of ulcerative colitis or Crohn's disease. Stool cultures were negative, as were assays for Clostridioides difficile toxin. An uneventful recovery ensued and no firm diagnosis was reached but it was assumed that this was an infective colitis.

Nonetheless, the abdominal x-ray shows the classic sign of colon wall edema - thumbprinting.

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