Thumbprinting Sign

Thumbprinting as a sign of submucosal hemorrhage or edema in colonic vascular occlusion was reported in two articles by Scott Boley and colleagues ¹ and Solomon Schwartz and co-workers ² , in 1963. The first article described the barium enema findings in five patients seen at the Jewish Hospital of Brooklyn and Downstate Medical Center (Figure 1). ‘The roentgenologic finding of importance is pseudotumor formation or ‘thumbprinting’. This appears to be caused by submucosal hemorrhage or by pericolic fat inflammation or both.’ ¹ The second article detailed the course of the radiographic changes in one of the original five patients. They confirmed their impressions of the radiographic findings by conducting animal experiments. ‘Pathologic examination, when marginal indentation or ‘thumbprinting’ was present, revealed two possible explanations: (1) submucosal hemorrhage and (2) inflammatory areas in pericolic fat.’ ¹ Recognizing these ‘pseudotumors’ as a sign of vascular disease is important. The vascular occlusion may only be temporary and the patient’s symptoms may resolve without surgical intervention. Figure 1 ‘Pseudotumors (‘thumbprinting’) are present along the superior aspect of the transverse colon.’ Reprinted from Boley et <italic>al.</italic> Reversible vascular occlusion of the colon. Surg. Gynecol <italic>Obstet,</italic> 1963, 116, 53–60, with permission of <italic>Surgery, Gynecology</italic> & Obstetrics, now known as <italic>the Journal of the American College of Surgeons</italic> https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig90_1_B.jpg"/>