When you’re rushing through a barium follow-through, one eye on the clock, the other on the resident who forgot to remove the ECG leads before the film… you don’t want to be scratching your head about Crohn’s disease radiology.
Enter “CHRONS” — a mnemonic that’s short, sharp, and surprisingly faithful to the chaos that Crohn’s brings to the gut.
Let’s decode it, feature by feature.
Mnemonic Table: “CHRONS”
| Letter | Feature | Explanation |
|---|---|---|
| C | Cobblestone appearance of mucosa | Mucosal ulceration and edema create that “old street of Paris” look. 🧱 Think more cobbles, less comfort. |
| H | Hyperplasia of mesenteric lymph nodes | Often seen on imaging, giving a “creeping fat” look on CT too. These lymph nodes are the gossip centers of the gut. |
| R | Rose-thorn ulcers | Deep, linear ulcers that look like nature’s own weapon of inflammation. Dr. Basit Khan once called them “the bayonets of bowel warfare.” |
| O | Obstruction of bowel | Due to chronic inflammation → strictures → partial/complete blockage. Classic Crohn’s curveball. 🚧 |
| N | Narrowing of lumen | Persistent inflammation leads to fibrosis and that sinister ‘string sign’ on barium studies. 🧵 |
| S | Skip lesions (+/- Sarcoid foci, Steatorrhoea) | Patchy involvement = hallmark. It’s like Crohn’s couldn’t decide where to cause chaos, so it went with “everywhere… selectively.” 🎯 |
We once had a patient from Mashkay, a tough young man with chronic abdominal pain and significant weight loss. His barium follow-through showed a classic cobblestone ileum, and a suspicious string sign at the terminal end — practically waving at us.
Dr. Faisal Afridi leaned over during the reporting and said, “This looks like an orthopedic cast — narrow, stiff, and a nightmare to deal with.”
I nodded, mostly because he had a way of comparing every pathology to a bone-related tragedy.
His CT abdomen also showed mesenteric lymph node hyperplasia — enough to make even Dr. Behroz Rahim joke, “This gut’s got more mood swings than my patients with bipolar disorder.” 😅
X-Ray tips for Crohn’s disease
- Don’t mistake rose-thorn ulcers for mere mucosal irregularities. They’re deeper, sharper, and classically linear.
- If you see obstruction + skip lesions, your differential list should shrink faster than the lumen.
- Always consider Crohn’s when you see discontinuous involvement with proximal and terminal ileal disease — and always correlate clinically (steatorrhea, weight loss, and yes, perianal disease too).
P.S.: If you’re prepping for FCPS or MRCP, commit this mnemonic to memory — I once survived an OSPE station purely on the strength of “CHRONS”… and a nervous grin.
Happy learning, folks! 🙂
Dr. Aurangzaib Qambrani
MBBS, PLAB, MRCP-UK
Gastroenterology & General Medicine
Sheikh Khalifa Bin Zayed Hospital, Quetta
