The Comb Sign in Crohn’s Ileocolitis

Signo del peine

“…La TC permite identificar la hipervascularización del mesenterio, la elevación de la atenuación de la grasa mesentérica (20-60 UH) y el aumento en el espacio entre la vasa recta, que dan la apariencia de los dientes de un peine (Fig. 1) 3,4 . La resonancia magnética (RM) también permite identificar los hallazgos que configuran el signo (Fig.…”

“…Aunque inicialmente el signo fue descrito en la EC, no se considera patognomónico de esta y ya ha sido observado en muchos otros procesos que afectan los vasos mesentéricos, incluyendo vasculitis por lupus u otras vasculitis como la poliarteritis nudosa, la púrpura de Schönlein-Henoch, el síndrome de Behçet, y en patologías como la tromboembolia mesentérica, la obstrucción intestinal y la colitis ulcerativa 3,4 .…”

“…Actualmente, no se considera que sea un signo patognomónico de la EC, pero sí un indicador de actividad y enfermedad avanzada 4 .…”

The comb sign in a patient with Crohn's disease

“…Computed tomography findings suggestive of Crohn's disease include bowel wall thickening, increased bowel wall enhancement after the administration of intravenous contrast media, 3 and parallel engorged mesenteric vessels known as the comb sign is not specific for Crohn's disease. This sign indicates an active disease with mesenteric hypervascularity that resembles the teeth of a comb and may be seen in vasculitis, mesenteric thromboembolism, and bowel strangulation 4 . It is difficult to detect mucosal abnormalities with a non‐contrast CT scan; however, the comb sign is not difficult to detect in CT scans without contrast media, and it is very useful though not specific for Crohn's disease.…”

“…This sign indicates an active disease with mesenteric hypervascularity that resembles the teeth of a comb and may be seen in vasculitis, mesenteric thromboembolism, and bowel strangulation. 4 It is difficult to detect mucosal abnormalities with a non‐contrast CT scan; however, the comb sign is not difficult to detect in CT scans without contrast media, and it is very useful though not specific for Crohn's disease. If you know the sign, it may be a clue to diagnose IBD.…”