Imaging Case of the Week 42

This supine abdominal x-ray is from a 20 year old male patient who presented with fever, abdominal pain and bloody diarrhoea which he has had for 10 days or so. What radiological sign can you see?

abdominal x-ray

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[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The abdominal x-ray shows normal calibre bowel loops; there is no evidence of bowel obstruction.

The radiological sign associated with this x-ray is the thumb printing sign which can clearly be seen on the left half of the transverse colon and the splenic flexure area.

Close-up view

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Thumb printing sign

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Thumb printing sign is due to marked oedematous folds of mucosa. The patient looked toxic, had a high temperature and tachycardia. He also had oral ulcers. The most likely cause of his presentation appears to be Crohn’s disease.

Thumb printing sign in the colon can also be seen in cases of:

  • Ischaemic colitis
  • Pseudomembranous colitis
  • Severe allergic reaction involving the GIT
  • Intestinal lymphoma and metastases