Question:medium
Identify the radiological sign given below.
Identify the radiological sign given below.
Show Hint
Smooth scalloped indentations at the splenic flexure watershed point to poor blood supply.
Updated On: Jun 23, 2026
- Diverticulitis
- Ischaemic colitis
- Appendicitis
- None
Show Solution
The Correct Option is B
Solution and Explanation
Sign-led reasoning: Rounded scalloped indentations on a barium enema are thumbprinting, and thumbprinting at the splenic flexure means ischaemic colitis.
When colonic blood supply fails, the submucosa fills with oedema and blood and bulges into the lumen as smooth, regular bumps that look as if a thumb were pressed into dough. The favourite site is the splenic flexure and descending colon, the watershed between the superior and inferior mesenteric territories, which is the first to suffer when perfusion drops. Plain radiographs may show splenic-flexure irregularity and a thickened bowel wall.
Option elimination: Diverticulitis would show sac-like outpouchings, not symmetric indentations. Appendicitis is a clinical and CT diagnosis, not a barium-enema thumbprint. 'None' is wrong because the sign is specific. So ischaemic colitis is the answer.
Ref: David Sutton, Textbook of Radiology and Imaging, 7th edition.
When colonic blood supply fails, the submucosa fills with oedema and blood and bulges into the lumen as smooth, regular bumps that look as if a thumb were pressed into dough. The favourite site is the splenic flexure and descending colon, the watershed between the superior and inferior mesenteric territories, which is the first to suffer when perfusion drops. Plain radiographs may show splenic-flexure irregularity and a thickened bowel wall.
Option elimination: Diverticulitis would show sac-like outpouchings, not symmetric indentations. Appendicitis is a clinical and CT diagnosis, not a barium-enema thumbprint. 'None' is wrong because the sign is specific. So ischaemic colitis is the answer.
Ref: David Sutton, Textbook of Radiology and Imaging, 7th edition.
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