Question:
Identify the radiological sign given below.
Identify the radiological sign given below.
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Smooth scalloped indentations at the splenic flexure watershed point to poor blood supply.
Updated On: Jun 23, 2026
- Diverticulitis
- Ischaemic colitis
- Appendicitis
- None
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The Correct Option is B
Solution and Explanation
Step 1: Read the sign. The barium study shows smooth, rounded indentations along the bowel wall, the classic 'thumbprinting' appearance, caused by submucosal oedema and haemorrhage bulging into the lumen.
Step 2: Localise it. The narrowing with a scalloped, thumbprinted edge involves the descending colon and splenic flexure region, a watershed zone with the poorest blood supply.
Step 3: Diagnose. Thumbprinting at the splenic flexure or descending colon is the hallmark of ischaemic colitis. Plain films often add splenic flexure irregularity with mural thickening.
Why the others are wrong: Diverticulitis shows outpouchings (diverticula) with possible localised narrowing, not diffuse thumbprinting. Appendicitis is not diagnosed on a barium enema sign like this.
Ref: David Sutton, Textbook of Radiology and Imaging, Volume 1, 7th edition, Page 653.
Step 2: Localise it. The narrowing with a scalloped, thumbprinted edge involves the descending colon and splenic flexure region, a watershed zone with the poorest blood supply.
Step 3: Diagnose. Thumbprinting at the splenic flexure or descending colon is the hallmark of ischaemic colitis. Plain films often add splenic flexure irregularity with mural thickening.
Why the others are wrong: Diverticulitis shows outpouchings (diverticula) with possible localised narrowing, not diffuse thumbprinting. Appendicitis is not diagnosed on a barium enema sign like this.
Ref: David Sutton, Textbook of Radiology and Imaging, Volume 1, 7th edition, Page 653.
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