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
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 abdominal pain for one day.
The abdominal radiograph showed colon gas terminated abruptly at the splenic flexure,
compatible with the colon cutoff sign ( Fig. 3 ).
A contrast-enhanced CT scan of the abdomen revealed peripancreatic fluid accumulation and fat stranding,
compatible with pancreatitis.
The effusion spread along the transverse mesocolon to the phrenicocolic ligament,
causing constricted lumen at the splenic flexure ( Fig. 4 ).
True colon cutoff sign on barium enema study
A 34-year-old male had a history of necrotizing pancreatitis 4 months ago with residual fluid collections at the peripancreatic and left anterior pararenal space.
The barium enema exam revealed an eccentric luminal narrowing near the splenic flexure ( Fig. 5 ).
Pseudo colon cutoff sign
A 95-year-old female demonstrated the PSEUDO colon cutoff sign with gas termination at the midportion of descending colon ( Fig. 6 ).
This image can be differentiated from the true colon cutoff sign obviously since the location is far from the splenic flexure,
where the phrenicocolic ligament inserted.
The coronal view of abdominal CT exhibited a circumferential soft tissue growth at the descending colon ( Fig. 7 ) and the histopathologic diagnosis for biopsy specimen was adenocarcinoma.
A 72-year-old female was evaluated for nausea and vomiting for 3 days.
The abdominal radiograph revealed dilated transverse colon with gas terminated near the splenic flexure ( Fig. 8 ).
Although both the cutoff of gas and location indicated the “colon cutoff sign”,
the CT scan of the abdomen with contrast demonstrated circumferential soft tissue growth with luminal narrowing and fatty infiltration ( Fig. 9 ).
Further histopathologic diagnosis was adenocarcinoma.
This case demonstrates that tumor growth at splenic flexure is a differential diagnosis must be listed.