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The Accordion Sign at CT: a Nonspecific Finding in Patients with Colonic Edema¹

¹ From the Department of Radiology, NYU Medical Center, Tisch Hospital, 560 First Ave, Suite HW 202, New York, NY 10016. Received July 28, 1998; revision requested August 18; revision received September 2; accepted November 25. Address reprint requests to M.M.

View larger version (116K): [in a new window]   Figure 1. Accordion sign in a 50-year-old woman with C difficile colitis. Marked submucosal edema (arrows) is present in the right colon. Oral contrast material (arrowhead) is trapped within the lumen.

View larger version (124K): [in a new window]   Figure 2a. Accordion sign in 44-year-old man with C difficile colitis. (a) Initial CT scan demonstrates markedly thickened and edematous submucosa (short arrow). On this image, the oral contrast material has not yet reached the colon. However, the enhancing mucosa (long arrow) simulates the accordion sign even though oral contrast material is not present. (b) On the follow-up CT scan obtained in the same patient 3 days later, the accordion sign is again depicted with edematous submucosa (arrow). Oral contrast material (arrowhead) is trapped within the lumen. In this case, the accordion sign was identified both with and without oral contrast material in the colon.

View larger version (129K): [in a new window]   Figure 2b. Accordion sign in 44-year-old man with C difficile colitis. (a) Initial CT scan demonstrates markedly thickened and edematous submucosa (short arrow). On this image, the oral contrast material has not yet reached the colon. However, the enhancing mucosa (long arrow) simulates the accordion sign even though oral contrast material is not present. (b) On the follow-up CT scan obtained in the same patient 3 days later, the accordion sign is again depicted with edematous submucosa (arrow). Oral contrast material (arrowhead) is trapped within the lumen. In this case, the accordion sign was identified both with and without oral contrast material in the colon.

View larger version (135K): [in a new window]   Figure 3a. Accordion sign in the right colon in a 42-year-old man with cirrhosis. (a) CT scan of the colon demonstrates the accordion sign with edematous submucosa (arrow). Oral contrast material (arrowhead) is trapped within the lumen. (b) CT scan of the liver demonstrates cirrhosis and a transjugular intrahepatic portosystemic shunt (arrow). Results of endoscopy in this patient demonstrated a normal mucosa, and the stool was negative for C difficile cytotoxin.

View larger version (140K): [in a new window]   Figure 3b. Accordion sign in the right colon in a 42-year-old man with cirrhosis. (a) CT scan of the colon demonstrates the accordion sign with edematous submucosa (arrow). Oral contrast material (arrowhead) is trapped within the lumen. (b) CT scan of the liver demonstrates cirrhosis and a transjugular intrahepatic portosystemic shunt (arrow). Results of endoscopy in this patient demonstrated a normal mucosa, and the stool was negative for C difficile cytotoxin.

View larger version (125K): [in a new window]   Figure 4. Accordion sign in a 43-year-old man with cryptosporidiosis. CT scan of the transverse colon demonstrates the accordion sign without oral contrast material present. The enhancing mucosa (arrowhead) is stretched around markedly thickened submucosal folds (arrow).

View larger version (129K): [in a new window]   Figure 5. Accordion sign in a 50-year-old woman with ischemic colitis. CT scan of the transverse colon demonstrates the accordion sign without oral contrast material present. The enhancing mucosa (arrowhead) is stretched around markedly thickened submucosal haustral folds (arrow). Findings at surgery confirmed ischemic colitis.