The comb sign in a patient with Crohn's disease

Ueda, Yoshibumi; Yanagi, Hidetaka

doi:10.1002/jgf2.499

Cited by 1 publication

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“…The bowel wall thickening may be focal or segmental, symmetrical or asymmetrical, concentric or eccentric, homogeneous or heterogeneous. The following signs were helpful in the identification of the location and extent of the diseased bowel segments: (1) Mesenteric inflammatory changes indicative of transmural inflammation: “fat stranding”[ 22 , 23 ], “creeping fat sign”[ 24 - 26 ] and “comb sign”[ 27 , 28 ]; (2) mural stratification indicative of edematous bowel wall (water holo sign) and submucosal fat deposition (fat holo sign)[ 17 - 21 ]; (3) intramural gas and/or subserosal pneumatosis indicative of aerogenous bacterial proliferation in the bowel wall[ 14 - 16 ]; (4) gas-liquid levels in the intestinal lumen indicative of intestinal dynamical abnormalities; (5) heterogeneity in the bowel wall texture especially with segmentally gas-filled and segmentally liquid-filled intestinal lumen; (6) inflamed diverticulitis; (7) epiplioic appendagitis; (8)“empty colon sign” or narrowed bowel lumen[ 15 , 16 ]; (9) adhesive bowel loop, especially with mesenteric inflammatory changes and/or adjacent peritoneal fibrotic thickening (“abdominal cocoon”)[ 29 - 32 ]; and (10) rugged colonic configuration, especially with mesenteric inflammatory changes and/or adjacent peritoneal fibrotic thickening.…”

Section: Methodsmentioning

confidence: 99%

Bowel inflammatory presentations on computed tomography in adult patients with severe aplastic anemia during flared inflammatory episodes

Zhao¹,

Xue²,

Song³

et al. 2023

World J Clin Cases

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BACKGROUND Patients with severe aplastic anemia (SAA) frequently present with inflammatory episodes, and during flared inflammatory episodes, hematopoietic function is further exacerbated. The gastrointestinal tract is the most common site for infectious and inflammatory diseases, and its structural and functional features confer on it the most potent capacity to affect hematopoietic and immune functions. Computed tomography (CT) is a readily accessible approach to provide highly useful information in detecting morphological changes and guiding further work-ups. AIM To explore CT imaging presentations of gut inflammatory damage in adult SAA patients during inflammatory episodes. METHODS We retrospectively evaluated the abdominal CT imaging presentations of 17 hospitalized adult patients with SAA in search of the inflammatory niche when they presented with systemic inflammatory stress and exacerbated hematopoietic function. In this descriptive manuscript, the characteristic images that suggested the presence of gastrointestinal inflammatory damage and related imaging presentations of individual patients were enumerated, analyzed and described. RESULTS All eligible patients with SAA had CT imaging abnormalities that suggested the presence of an impaired intestinal barrier and increased epithelial permeability. The inflammatory damages were concurrently present in the small intestine, the ileocecal region and the large intestines. Some readily identified imaging signs, such as bowel wall thickening with mural stratification (“water holo sign”, “fat holo sign”, intramural gas and subserosal pneumatosis) and mesenteric fat proliferation (fat stranding and “creeping fat sign”), fibrotic bowel wall thickening, “balloon sign”, rugged colonic configuration, heterogeneity in the bowel wall texture, and adhered and clustered small bowel loop (including various patterns of “abdominal cocoon”), occurred at a high incidence, which suggested that the damaged gastrointestinal tract is a common inflammatory niche responsible for the systemic inflammatory stresses and the exacerbated hematopoietic failure in patients with SAA. Particularly, the “fat holo sign” was present in 7 patients, a rugged colonic configuration was present in 10 patients, the adhesive bowel loop was present in 15 patients, and extraintestinal manifestations suggestive of tuberculosis infections were present in 5 patients. According to the imaging features, a suggestive diagnosis of Crohn’s disease was made in 5 patients, ulcerative colitis in 1 patient, chronic periappendiceal abscess in 1 patient, and tuberculosis infection in 5 patients. Other patients were diagnosed with chronic enteroclolitis with acutely aggravated inflammatory damage. CONCLUSION Patients with SAA had CT imaging patterns that suggested the presence of active chronic inflammatory conditions and aggravated inflammatory damage during flared inflammatory episo...

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