Which findings on plain radiographs are characteristic of ulcerative colitis (UC)?

Updated: Feb 23, 2019
  • Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

Plain radiographs frequently yield useful information that may serve as a guide to further clinical evaluation and imaging (see the images below). The intraluminal gas pattern may show pseudopolyposis and deep ulcers. The colon may appear shortened, with associated loss of colonic haustra. Toxic megacolon is a complication of ulcerative colitis. The plain abdominal radiograph may show massive colonic dilatation associated with an abnormal mucosal contour. The dilatation is most pronounced in the transverse colon. Colonic perforation is another known complication of ulcerative colitis. Perforation may occur with or without a toxic megacolon. Pneumoperitoneum associated with a colonic perforation is usually massive. Fecal residue may be absent in inflamed bowel.

Plain abdominal radiograph in a patient with known Plain abdominal radiograph in a patient with known ulcerative colitis who presented with abdominal pain, peritonism, and leukocytosis. At surgery, a perforated toxic megacolon superimposed on ulcerative colitis was confirmed.
Increased postrectal space is a known feature of u Increased postrectal space is a known feature of ulcerative colitis.
Plain abdominal radiograph on a patient with known Plain abdominal radiograph on a patient with known ulcerative colitis who presented with an acute exacerbation of his symptoms. Image shows thumbprinting in the region of the splenic flexure of the colon.
Plain abdominal radiograph in a 26-year-old with a Plain abdominal radiograph in a 26-year-old with a 10-year history of ulcerative colitis shows a long stricture/spasm of the ascending colon/cecum. Note the pseudopolyposis in the descending colon.
Lateral radiograph of the lumbar spine shows a bam Lateral radiograph of the lumbar spine shows a bamboo spine.

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