String Sign

Only 2 years after Burrill Crohn and colleagues ¹ described regional ileitis as a pathologic and clinical entity (see Cobblestone pattern), John Kantor ² reported its diagnostic roentgenographic features. Kantor worked with the same surgeons and pathologists as Crohn and his colleagues’. His report was based on six cases and included a description of the ‘string sign’ (Figure 1). ‘Perhaps the most striking finding is the ‘string sign’… This is a thin, slighdy irregular linear shadow suggesting a cotton string in appearance and extending more or less continuously from the region of the last visualized loop of ileum through the entire extent of the filling defect and ending at the ileocecal valve. It represents the attenuated barium filling of the gready contracted intestinal lumen. A characteristic ‘string sign’ is apparent in the illustration of the original article by Crohn and his collaborators.’ ² Kantor said the name ‘string sign’ was ‘borrowed from A.W. Crane.’ In the discussion that followed Kantor’s article, Crohn endorses the sign saying, ‘It is a fitting term. The string sign is absolutely characteristic’ Kantor, however, did not consider it to be a pathognomonic sign. Tuberculomas, syphilitic colitis and stenosing sarcomas of the terminal ileum had also been reported with a similar radiographic appearance. Figure 1 ‘Regional (terminal) ileitis, showing multiple string signs.’ Reprinted from Kantor<xref ref-type="bibr" rid="ref85_2"> ² </xref>. Regional (terminal) ileitis. J. <italic>Am. Med. Assoc,</italic> 1934, 103, 2016–2021, copyright 1934, American Medical Association https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig85_1_B.jpg"/>