ª Springer Science+Business Media New York 2015
Abdominal Imaging
Abdom Imaging (2015) DOI: 10.1007/s00261-015-0487-8
The colonic thumbprinting sign Ashish Chawla, Wei Lun Tim, Tze Chwan Lim Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
‘‘Thumbprints’’ (Fig. 1) have been used to describe thickened and edematous colonic haustra that project into the air-filled colonic lumen, as seen on standard abdominal radiograph (Fig. 2). Although the sign was initially considered highly suggestive of pseudomembranous colitis, it can be seen in a number of other bowel disorders, most important being ischemic colitis and inflammatory bowel disease [1–3]. Regardless of the etiology, the inflammation leads to intense mucosal and submucosal edema with resultant nodular thickening of haustra that appear as soft tissue projections in the airfilled lumen of involved bowel (Fig. 2). These soft tissue nodules resemble regularly placed thumbprints on an abdominal radiograph. Clinical information is useful in
Correspondence to: Ashish Chawla; email: [email protected]
differentiating between the various etiologies. Patients with pseudomembranous colitis usually present with a history of antibiotics use, while ischemic colitis is generally seen in patients over 70 years of age, typically with predisposing vascular risk factors. Inflammatory bowel disease typically presents in younger patients. Contrastenhanced computed tomography (CT) of the abdomen is also useful in differentiating various etiologies of colitis. Colonoscopy is usually performed to evaluate the bowel and obtain tissue samples for accurate diagnosis (Fig. 3). In the present case, the thumbprinting was secondary to a combination of numerous pseudopolyps in the colonic wall and haustral thickening due to ulcerative colitis.
A. Chawla et al.: The colonic ‘‘thumbprinting’’ sign
Fig. 2. 20-year-old woman presenting to emergency department with left-side abdominal pain and bloody diarrhea. Abdominal radiograph shows multiple soft tissue nodules (black arrowheads) projecting in the lumen of descending colon and sigmoid colon resembling ‘‘thumbprinting’’.
Fig. 1.
Photograph of a series of thumbprints.
A. Chawla et al.: The colonic ‘‘thumbprinting’’ sign
References 1. Stanley RJ, Melson GL, Tedesco FJ, Saylor JL (1976) Plain-film findings in severe pseudomembranous colitis. Radiology 118:7–11 2. Horton KM, Fishman EK (2001) Computed tomography evaluation of intestinal ischemia. Semin Roentgenol 36:118–122 3. Lichtenstein JE (1987) Radiologic-pathologic correlation of inflammatory bowel disease. Radiol Clin North Am 25:3–24
Fig. 3. A, B Colonoscopy in the same patient shows haustral thickening, ulcers, and pseudopolps in lower descending colon.
Abdominal Imaging
Abdom Imaging (2015) DOI: 10.1007/s00261-015-0487-8
The colonic thumbprinting sign Ashish Chawla, Wei Lun Tim, Tze Chwan Lim Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
‘‘Thumbprints’’ (Fig. 1) have been used to describe thickened and edematous colonic haustra that project into the air-filled colonic lumen, as seen on standard abdominal radiograph (Fig. 2). Although the sign was initially considered highly suggestive of pseudomembranous colitis, it can be seen in a number of other bowel disorders, most important being ischemic colitis and inflammatory bowel disease [1–3]. Regardless of the etiology, the inflammation leads to intense mucosal and submucosal edema with resultant nodular thickening of haustra that appear as soft tissue projections in the airfilled lumen of involved bowel (Fig. 2). These soft tissue nodules resemble regularly placed thumbprints on an abdominal radiograph. Clinical information is useful in
Correspondence to: Ashish Chawla; email: [email protected]
differentiating between the various etiologies. Patients with pseudomembranous colitis usually present with a history of antibiotics use, while ischemic colitis is generally seen in patients over 70 years of age, typically with predisposing vascular risk factors. Inflammatory bowel disease typically presents in younger patients. Contrastenhanced computed tomography (CT) of the abdomen is also useful in differentiating various etiologies of colitis. Colonoscopy is usually performed to evaluate the bowel and obtain tissue samples for accurate diagnosis (Fig. 3). In the present case, the thumbprinting was secondary to a combination of numerous pseudopolyps in the colonic wall and haustral thickening due to ulcerative colitis.
A. Chawla et al.: The colonic ‘‘thumbprinting’’ sign
Fig. 2. 20-year-old woman presenting to emergency department with left-side abdominal pain and bloody diarrhea. Abdominal radiograph shows multiple soft tissue nodules (black arrowheads) projecting in the lumen of descending colon and sigmoid colon resembling ‘‘thumbprinting’’.
Fig. 1.
Photograph of a series of thumbprints.
A. Chawla et al.: The colonic ‘‘thumbprinting’’ sign
References 1. Stanley RJ, Melson GL, Tedesco FJ, Saylor JL (1976) Plain-film findings in severe pseudomembranous colitis. Radiology 118:7–11 2. Horton KM, Fishman EK (2001) Computed tomography evaluation of intestinal ischemia. Semin Roentgenol 36:118–122 3. Lichtenstein JE (1987) Radiologic-pathologic correlation of inflammatory bowel disease. Radiol Clin North Am 25:3–24
Fig. 3. A, B Colonoscopy in the same patient shows haustral thickening, ulcers, and pseudopolps in lower descending colon.
