Thumbprinting and accordion sign

Case contributed by Dr Jayanth Keshavamurthy


Severe diarrhoea.

Patient Data

Age: 69
Gender: Male

Name the sign

Gas pattern: No supine evidence of free peritoneal air. There is a mucosal thickening demonstrated by the thumbprinting sign in the ascending colon. There is a paucity of bowel gas in the descending colon. However correlating
with the CT abdomen, likely favours diffuse colitis with a paucity of bowel gas in this region.

No toxic megacolon.

Annotated image

Thumbprinting from mucosal oedema.

Severe oedema of descending colon from colitis , see CT for correlation.


Name the sign.

Accordion sign.

1. Diffuse circumferential wall thickening of the colon and rectum, which remains consistent with a pancolitis and proctitis.  Accordion sign is seen.

2.Third spacing and free fluid in peritoneum.

3. Enteric contrast is noted throughout the stomach, duodenum, jejunum, and ileum. No CT evidence for mechanical bowel obstruction.

4. No free air is identified on today's exam to suggest viscus perforation.

5. There is diffuse small bowel wall thickening, which is, at least in part, secondary to fluid overload. However, developing enteritis cannot be excluded.

Case Discussion

Classic radiologic features of severe colitis, here considered infectious in origin due to clostridium difficile.

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Case information

rID: 46188
Published: 25th Jun 2016
Last edited: 28th Jun 2016
Inclusion in quiz mode: Included

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