Year 2023 / Volume 115 / Number 4
Letter
Comb sign in Crohn’s disease

205

DOI: 10.17235/reed.2022.9132/2022

Akira Hokama, Atsushi Iraha,

Abstract
We present a case of a 13-year-old boy with Crohn's disease (CD) who presented with abdominal pain and diarrhea. On examination, there was tenderness on the lower abdomen. Laboratory examinations showed elevated inflammatory parameters. A CT scan showed active inflammation of the ileum and rectosigmoid colon with the comb sign. A diagnosis of exacerbation of CD was made. The comb sign refers to hypervascularity of the mesentery with vascular dilatation, tortuosity, and wide spacing of the vasa recta that are aligned as the teeth of a comb. This sign is not always pathognomonic for CD; however, it may help identification of acute exacerbation in known CD and differentiating active CD from hypovascular disease such as lymphoma. The comb sign can be highly correlated with the endoscopic severity rather than mural thickening in CD.
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References
1. Madureira AJ. The comb sign. Radiology 2004;230:783-4.
2. Meyers MA, McGuire PV. Spiral CT demonstration of hypervascularity in Crohn disease: "vascular jejunization of the ileum" or the "comb sign". Abdom Imaging 1995;20:327-32.
3. Di Martino M, García Sanz Í, Muñoz de Nova JL, et al. Comb sign in intestinal obstruction secondary to desmoplastic reaction due to an ileal neuroendocrine tumor. Rev Esp Enferm Dig 2015;107:697-8.
4. Sakurai T, Katsuno T, Saito K, et al. Mesenteric findings of CT enterography are well correlated with the endoscopic severity of Crohn's disease. Eur J Radiol 2017;89:242-8.
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Hokama A, Iraha A. Comb sign in Crohn’s disease. 9132/2022


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Publication history

Received: 13/08/2022

Accepted: 29/08/2022

Online First: 12/09/2022

Published: 03/04/2023

Article Online First time: 30 days

Article editing time: 233 days


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