Plain-film findings in severe pseudomembranous colitis

Plain-film abdominal changes in 5 patients with severe antibiotic-related pseudomembranous colitis were found to be strikingly similar and distinct from those seen in other colitides. These consisted of moderate gaseous distension of the colon and unusual wide transverse bands of thickened bowel wall associated with giant "thumbprinting" which was universal in distribution, with minimal or absent small-bowel abnormalities. While the radiographic findings were not pathognomonic, they were highly suggestive of advanced pseudomembranous colitis when combined with the clinical data. Prompt recognition of this entity by the radiologist is extremely helpful in management, since such patients frequently present with physical findings of an acute abdomen requiring surgery.