Imaging Case of the Week 198 Answer

The supine abdominal x-ray indicates severely dilated large bowel loops with mucosal oedema (as per the thumb printing sign). The erect abdominal x-ray show multiple air fluid levels. The x-ray is concerning for a toxic mega colon, a well-known complication of ulcerative colitis.

dilated large bowel loopsmultiple fluid levels

A CT scan of the abdomen confirmed the diagnosis.

Axial CT abdomenCoronal CT abdomen