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Case of the Week 352 
What's the most likely diagnosis?
- 75 year-old with abdominal pain; the sign shown is called the:
Supine radiograph of abdomen (disregard the gallstones)
- Pawnbroker's sign
- Sigmoid elevator sign
- Crescent sign
- Rigler's sign
- Colon cutoff sign
Additional Image - Contrast-enhanced CT of abdomen
Additional Image
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Contrast-enhanced CT of upper abdomen
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Answer:
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5. Colon cutoff sign (here shown in mesenteric ischemia)
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More (Click Discussion Tab)
Colon Cutoff Sign
General Considerations
- The pattern of bowel gas in which there is air in a slightly dilated transverse colon up to, but not beyond, the splenic flexure
- Originally described on conventional radiography, it has the same appearance and implications on CT
- In pancreatitis, the disease in which it was described, it is caused by inflammatory exudate from the pancreas which infiltrates the transverse mesocolon via the phrenicocolic ligament
- The phrenicocolic ligament is a peritoneal fold extending from the splenic flexure to the posterolateral aspect of the left hemidiaphragm
- The spleen rests on the shelf formed by this ligament
- This produces spasm of the transverse colon or actual physical narrowing of the splenic flexure
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This Week
75 year-old with abdominal pain demonstrates a helpful radiologic sign |
This video podcast reviews the uses, placement, complications and malpositions of umbilical arterial and venous catheters; there is a mini-quiz included |
A trim mobile version for your PDA or internet-enabled smartphone with handy lists of differential diagnoses, most commons and more
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Key points on recognizing the most common fractures and dislocations |
Basic CT imaging of the brain focusing on the findings of cerebrovascular accidents |
The top diagnostic imaging diagnoses that all medical students should recognize according to the Alliance of Medical Student Educators in Radiology |
Recognizing normal and key abnormal intestinal gas patterns, free air and abdominal calcifications |
Some of the fundamentals of interpreting chest images |
UPDATED 
| LearningRadiology.com |
is an award-winning educational website aimed primarily at medical students and radiology residents-in-training, containing lectures, handouts, images, Cases of the Week, archives of cases, quizzes, flashcards of differential diagnoses and “most commons” lists, primarily in the areas of chest, GI, GU cardiac, bone and neuroradiology. |
