Colon cutoff sign – more than cutoff

Congress:

ECR 2019

Poster Number:

C-2903

Type:

Educational Exhibit

Keywords:

Obstruction / Occlusion, Inflammation, Cancer, Diagnostic procedure, CT, Conventional radiography, Colon, Anatomy

Authors:

T.-M. LIN, R.-C. Lee; Taipei/TW

DOI:

10.26044/ecr2019/C-2903

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2903

Fig. 1: This plain radiography demonstrates the typical colon cutoff sign with abrupt...

Fig. 3: The colon gas terminates abruptly at the splenic flexure on this abdominal...

Fig. 5: The barium enema study reveals an eccentric luminal narrowing (arrow) near the...

Fig. 6: A PSEUDO colon cutoff sign with colon gas terminates at the midportion of...

Fig. 8: A dilated transverse colon with gas terminates near the splenic flexure (arrow).

Learning objectives

To identify the true and pseudo colon cutoff sign.

Background

The colon cutoff sign was originally proposed as the termination of colon gas at splenic flexure due to exudate in phrenicocolic ligament causing focal spasm or narrowing when colon entering into the retroperitoneal space1. Two necessary components must exist when identifying this sign: the cutoff of colon gas and the location at splenic flexure near the phrenicocolic ligament. Some may only notice the abrupt termination of gas literally but ignore the importance of location2. The phrenicocolic ligament is a peritoneal fold extending from the splenic...

Findings and procedure details

True colon cutoff sign on abdominal radiograph A 91-year-old female revealed the true colon cutoff sign, with abrupt cutoff of colon gas at the splenic flexure on the abdominal radiograph( Fig. 1 ). Computed tomography of the abdomen showed edematous change with necrotic fluid collection around the tail of pancreas extending to the left anterior pararenal space, compatible with acute necrotizing pancreatitis. Fluid accumulation along the thickened phrenicocolic ligament with spasm of the splenic flexure was noted( Fig. 2 ). A 39-year-old male presented with...

Conclusion

When interpreting a radiologic sign, we should also realize the underlying mechanism to prevent misusage.

Personal information

Contact details: Dr. Te-Ming Lin Resident in training. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan. Email: [email protected] Dr. Rheun-Chuan Lee Chief. Division of Abdominal Radiology, Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.

References

1.Pickhardt PJ. The colon cutoff sign. Radiology. 2000;215:387-389 2.Chen P-Y. Colon cutoff sign. New England Journal of Medicine. 2018;378:1621-1621 3.Meyers, Morton A. Roentgen significance of the phrenicocolic ligament. Radiology. 1970;95:539-545