The little rose sign

Excerpt

The little rose sign first described by Romano et al. [1] refers to the aspect of ischemic colitis at the early stage of the disease on unenhanced CT. This typical feature corresponds to hyperdensity of mucosa and submucosal edema [2] (Figs. 1, 2). Ischemic colitis is considered a form of nonocclusive ischemic disease typically seen in the elderly [3]. Many precipitating factors such as atherosclerosis, hypotension, vasculitis, heart disease, cardiac and aortic surgery, and also some medications have been incriminated by reducing blood flow to the colon [3, 4]. Ischemic colitis presents two distinct patterns of severity [4, 5]. The histopathologic manifestations of ischemic colitis are either mucosal ulcerations, submucosal edema and hemorrhage or transmural infarction [3]. Presenting symptoms include abdominal pain and rectal bleeding. Since CT nowadays is performed in most patients presenting with an acute abdomen, radiologists should be aware of the CT appearance of this disease including the typical little rose sign that can help to distinguish an ischemic cause from the other causes of acute colitis (infectious, inflammatory) responsible for quite similar parietal thickening of the colon [6]. Most ischemic colitis diagnosed and treated at the early stage of the disease responds well to simple conservative treatment, while ischemic colitis seen at the late stage warrants surgical treatment [4].

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