Radiological Signs (Shënja Radiologjike )-2

1

Sllavko K. Kallfa

Radiological Signs

(Shënja Radiologjike)

Përmbledhje Artikujsh nga

Radiopaedia.org

❷

2

inanimate object inspired X-Ray signs

champagne glass pelvis.......f. 3

coin lesion...............................................f.4

dinner fork deformity...........f.11

fishhook ureters............................f.13

goblet sign.............................................f.16

leather bottle stomach

Lincoln log vertebra...............f.17

napkin ring sign...........................f.26

rugger-jersey spine..................f.30

Tam O'Shanter sign...............f.38

water bottle sign..........................f.41

white pyramid sign..................f.45

3

Champagne glass pelvis

Dr Ayush Goel and Dr MT Niknejad et al.

The champagne glass pelvis is a helpful sign in achondroplasia which the iliac blades are

flattened, giving rise to a pelvic inlet and resembles a champagne glass. The acetabular angles

are increased, and the sacrosciatic notch is small.

References

1. Roche CJ, O'Keeffe DP, Lee WK et-al. Selections from the buffet of food signs in

radiology. Radiographics. 2002;22 (6): 1369-84. Radiographics (full text) -

doi:10.1148/rg.226025521 - Pubmed citation

2. Davies SG. Aids to Radiological Differential Diagnosis. Saunders Ltd. (2009)

ISBN:0702029793. Read it at Google Books - Find it at Amazon

Synonyms & Alternative Spellings

Synonyms or Alternative Spelling Include in Listings?

Champagne glass type pelvic inlet ✗

Champagne glass sign of pelvis ✗

Champagne glass appearance of pelvis

4

Coin lesion

Dr Henry Knipe et al.

Coin lesion refers to a round or oval, well-circumscribed solitary pulmonary lesion. It is

typically 1-5 cm in diameter and calcification may or may not be present 1,3

. Typically but not

always the patient is asymptomatic 1.

Differential diagnosis

The differential diagnosis for such lesions is 1-3

:

primary lung malignancy - e.g. squamous cell carcinoma

metastases

infection

o pulmonary tuberculosis;

o Streptococcus sp., Staphlycoccus sp., or Klebisialla sp. infection

o hydatid cyst

o abscess

benign disease processes

o Wegener's granulomatosis

o pulmonary hamartoma

o pulmonary arteriovenous malformation

o rheumatoid nodule

o bronchogenic cyst

o bronchial adenoma

Take care not to call a "pseudo-coin lesion", which are caused by artifacts (e.g. button on

patient's clothing, unilateral nipple shadow, etc).

See also

solitary pulmonary nodule

References

1. The pulmonary "coin" lesion [editorial]. Radiology. 1950; 54(1):116-117.

2. Chowdhury R. Radiology at a glance. John Wiley (2013).

3. Parr LH. Coin lesions of the lung. J Natl Med Assoc. 1969;61 (2): 153-7. Free text at

pubmed - Pubmed citation

5

Synonyms & Alternative Spellings

Synonyms or Alternative Spelling Include in Listings?

Coin lesions ✗

Pulmonary coin lesion

From the case: Pulmonary coin lesion

Modality: X-ray

6

From the case: Coin lesion (lung adenocarcinoma)

Modality: X-ray

7

From the case: Coin lesion - breast cancer metastasis

Modality: X-ray

8

From the case: Coin lesion - colorectal carcinoma metastasis

Modality: X-ray

9

Imaging Differential Diagnosis

From the

case: Pseudo-coin lesion due to button

Modality: X-ray

10

From the case: Pseudo-

coin lesion due to button

Modality: X-ray

11

Dinner fork deformity

Dr Henry Knipe and Dr Frank Gaillard et al.

A dinner fork deformity (also known as a bayonet deformity) occurs as the result of a

malunited distal radial fracture, usually a Colles fracture. The distal fragment is dorsally

angulated, displaced and often also impacted. The term is descriptive, as the lateral view of the

wrist is similar to the shape of a fork, seen from the side, tines down.

See also

Colles fracture

upper extremity fractures

References

1. Hertling D, Kessler RM. Management of common musculoskeletal disorders, physical

therapy principles and methods. Philadelphia : Lippincott Williams & Wilkins, c2006.

(2006) ISBN:0781736269. Read it at Google Books - Find it at Amazon

2. Roche CJ, O'keeffe DP, Lee WK et-al. Selections from the buffet of food signs in

radiology. Radiographics. 22 (6): 1369-84. doi:10.1148/rg.226025521 - Pubmed citation

3.Maizlin ZV, Kuruvilla M, Clement JJ et-al. Radiologic signs of weapons and

munitions: How will noncombatants recognize them?. AJR Am J Roentgenol. 2010;195

(2): W96-104. doi:10.2214/AJR.09.4029 - Pubmed citation

Synonyms & Alternative Spellings

Synonyms or Alternative Spelling Include in Listings?

Bayonet deformity

12

From

the case: Colles fracture

Modality: X-ray

13

Fishhook ureters

Dr Frank Gaillard et al.

Fishhook ureters, also known as "J-shaped ureters" or "hockey stick ureter" describe the course

of the distal ureter in patients with significant Benign prostatic hypertrophy. It has also been used

to describe the appearance of a retrocaval ureter further up, as the right ureter hooks behind the

IVC. In this case it has also been refered to as an S-shaped ureter.

References

1. Mulligan ME. Classic radiologic signs, an atlas and history. Informa HealthCare.

(1997) ISBN:1850706646. Read it at Google Books - Find it at Amazon

2. Uthappa MC, Anthony D, Allen C. Case report: retrocaval ureter: MR appearances. Br

J Radiol. 2002;75 (890): 177-9. Br J Radiol (full text) - Pubmed citation

14

MIP Original photo

of inset fishing hook taken by Mike Cline (available through Wikipedia.org) From the case: Fishhook

ureter

Modality: CT

15

From the case:

Fishhook ureter

Modality: CT

16

Goblet sign

Dr Yuranga Weerakkody and Dr Frank Gaillard et al.

The goblet sign (or champagne glass sign) refers to the appearance of the ureter when it is

focally dilated by an intraluminal mass. It is best seen when the ureter is opacified from below,

by a retrograde ureterogram. Presence of this sign indicates the pathology to be chronic,

permitting the lesion to be accommodated in the ureter.

Although most frequently caused by transitional cell carcinoma, a number of other entities can

lead to the same appearance 1:

transitional cell carcinoma of the ureter : most common

metastatic disease

endometriosis

References

1. Dyer RB, Chen MY, Zagoria RJ. Classic signs in uroradiology. Radiographics.

2004;24 Suppl 1 : S247-80. doi:10.1148/rg.24si045509 - Pubmed citation

Synonyms & Alternative Spellings

Synonyms or Alternative Spelling Include in Listings?

Champagne glass sign ✗

Edit Article Share

Photograph - glass goblet

17

H-shaped vertebra

Dr Andrew Dixon and Dr Frank Gaillard et al.

H-shaped vertebra (also known as Lincoln log vertebra) are a characteristic finding of sharply

delimited central endplate depression classically seen in approximately 10% of patients with

sickle-cell anaemia and results from microvascular endplate infarction 3.

It may occasionally be seen with other conditions such as Gaucher disease 1-2

.

References

1. Schwartz AM, Homer MJ, Mccauley RG. "Step-off" vertebral body: Gaucher's disease

versus sickle cell hemoglobinopathy. AJR Am J Roentgenol. 1979;132 (1): 81-5. AJR

Am J Roentgenol (abstract) - Pubmed citation

2. Lenchik L, Rogers LF, Delmas PD et-al. Diagnosis of osteoporotic vertebral fractures:

importance of recognition and description by radiologists. AJR Am J Roentgenol.

2004;183 (4): 949-58. AJR Am J Roentgenol (full text) - Pubmed citation

3. Lonergan GJ, Cline DB, Abbondanzo SL. Sickle cell anemia. Radiographics. 21 (4):

971-94. Radiographics (full text) - Pubmed citation

Synonyms & Alternative Spellings

Synonyms or Alternative Spelling Include in Listings?

Lincoln log vertebra ✓

H-shaped vertebrae ✗

Step off vertebra ✓

Lincoln log vertebrae ✗

H shaped vertebra

18

This 29 year-old female patient presented

with a chest infection, and a CXR was performed. The patient had a history of sickle-cell anaemia. The

lateral CXR shows multiple vertebral end-plate irregularities and depressions. The peripheral portions of

the end-plates are spared. The appearance is due to bone infarction and subsequent collapse. This is an

early example of the classical H-shaped vertebrae seen in sickle-cell anaemia. H-shaped vertebrae are a

characteristic finding seen in approximately 10% of patients with the disease. Bone infarction may be

complicated by Salmonella osteomyelitis. Other signs to look for on chest films are cardiomegaly, absent

spleen, and cholecystectomy clips. Reference Pope TL. Aunt Minnie’s Atlas & Imaging Specific Diagnosis.

2nd edition. Lippincott, Williams & Wilkins 2003 Image contributed by: Dr Laughlin Dawes center center

center This image is made available under a Creative Commons Licence. If you wish to use this image

outside of this licence, then please contact the author above.

19

From the case:

Sickle cell spine

Modality: X-ray

20

From the case: H-shaped vertebrae

Modality: X-r

21

From the case: Sickle cell disease - hip AVN and H-shaped vertebrae

Modality: X-ray

22

23

From the case: H shaped vertebrae - sickle

cell disease

Modality: X-ray

24

From the case: Sickle cell anaemia - spinal MRI

Modality: MRI

25

From the case: Sickle cell disease

Modality: CT

26

Apple core sign - colon

Dr Henry Knipe and Dr MT Niknejad et al.

The apple core sign, also known as a napkin ring sign (bowel), is most frequently associated

with constriction of the lumen of the colon by a stenosing annular colorectal carcinoma.

Differential diagnosis

The appearance of the apple-core lesion of the colon also can be caused by other diseases 3:

lymphoma with colonic involvement - appears more diffuse

Crohn’s disease

chronic ulcerative colitis

ischaemic colitis

Chlamydia infection

colonic tuberculosis

Helminthoma

colonic amoebiasis

colonic cytomegalovirus

villous adenoma

radiosurgery such as high doses of Cyberknife used for treating unresectable abdominal

malignancies

See also

napkin-ring sign (cardiac)

apple core sign (femur)

References

1. Mulligan ME. Classic radiologic signs, an atlas and history. Informa HealthCare.

(1997) ISBN:1850706646. Read it at Google Books - Find it at Amazon

2. Freyschmidt J. The apple core sign. Eur Radiol. 2002;12 (1): 245-7. Eur Radiol

(abstract) - doi:10.1007/s00330-001-1193-1 - Pubmed citation

3. Alzaraa A, Krzysztof K, Uwechue R et-al. Apple-core lesion of the colon: a case

report. Cases J. 2009;2 (1): 7275. doi:10.4076/1757-1626-2-7275 - Free text at pubmed -

Pubmed citation

27

Synonyms & Alternative Spellings

Synonyms or Alternative Spelling Include in Listings?

Napkin ring sign - colon ✓

Apple core sign of the colon ✗

Apple core appearance of the colon

Typical apple-core sign of the colon

28

Acute marginal angles or shouldering sign may disappear proximally because of its dilatation.

29

Grey-scalerom the case: Apple core sign

Modality: Barium Acute marginal angles or shouldering sign may disappear proximally because of its dilatation.

30

Rugger-jersey spine

Dr Frank Gaillard et al.

Rugger-jersey spine describes the prominent subendplate densities at multiple contiguous levels

to produce an alternating dense-lucent-dense appearance. This simulates the transverse bands of

a rugby jersey.

This term and pattern is distinctive for hyperparathyroidism.

Differential diagnosis

Paget disease - picture frame vertebral body

osteopetrosis - sandwich vertebral body

Note: some authors use the term rugger jersey for osteopetrosis, although most would assume the

term refers to hyperparathyroidism.

References

1. Terry R. Yochum, Lindsay J. Rowe. Yochum and Rowe's Essentials of skeletal

radiology. Philadelphia, Pa. : Lippincott Williams & Wilkins, c2005. ISBN:0781739462.

Read it at Google Books - Find it at Amazon

Synonyms & Alternative Spellings

Synonyms or Alternative Spelling Include in Listings?

Rugger jersey sign ✗

Rugby jersey sign

31

Prominent sub-endplate densities at multiple contiguous levels produce

an alternating dense-lucent-dense appearance simulating the transverse bands of rugby sweater

(rugger-jersey spine). This pattern is distinctive for hyperparathyroidism (like this case has secondary

hyperparathyroidism due to chronic renal failure) though, there is similarity to some cases of

osteopetrosis. Reference Youchum and Rowe’s: Essentials of Skeletal Radiology, 2005 Credit Dr Ahmed

Haroun

32

Rugger jersey spine

33

From the case: Rugger jersey spine

sign

34

From

the case: Rugger jersey spine (MRI)

Modality: MRI

35

From the case: Rugger-jersey spine

Modality: CT

36

From the

case: Rugger-jersey spine

Modality: X-ray

37

Imaging Differential Diagnosis

bone window

Typical "rugger jersey" spine with dense posterior appendages and bilateral pars interarticularis defects

from L1 to L5 - note only mild anterior spondylolithesis at L5/S1 From the case: Osteopetrosis

Modality: CT

38

Tam O'Shanter sign

Dr Frank Gaillard et al.

The "Tam O'Shanter" is a Scottish hat, named after the character in Robert Burn's 1 poem of

the same name. The appearances of advanced Paget's disease of the skull are similar in

appearance to the hat.

Paget's involvement of the skull, with widening of the diploic space and an overall enlargment of

the cranium, combinded with platybasia, leads to the appearnce of the skull falling over the facial

bones, such as a Tam O'Shanter hat would fall over the head.

Other Paget's disease related signs

blade of grass sign jigsaw pattern bone or mosaic pattern bone picture frame vertebra cotton wool appearance of bone banana fracture

Other inanimate object inspired signs.

References

1. Smith SE, Murphey MD, Motamedi K et-al. From the archives of the AFIP. Radiologic spectrum of Paget disease of bone and its complications with pathologic correlation. Radiographics. 2002;22 (5): 1191-216. Radiographics (full text) - Pubmed citation

2. Richards PS, Bargiota A, Corrall RJ. Paget's disease causing an Arnold-Chiari Type 1 malformation: radiographic findings. AJR Am J Roentgenol. 2001;176 (3): 816-7. doi:10.2214/ajr.176.3.1760816 - Pubmed citation

39

Synonyms & Alternative Spellings

Synonyms or Alternative Spelling Include in Listings?

The Tam O'Shanter sign

Hat which inspired the Tam

O'Shanter sign of Paget's disease Original file here.

40

From the case: Paget's disease of the skull

Modality: CT

41

Water bottle sign

Dr Henry Knipe and Dr Frank Gaillard et al.

The water bottle sign or configuration refers to the shape of the cardiac silhouette on erect

frontal chest x-rays in patients who have a very large pericardial effusion. Typically the effusion

has accumulated over many weeks to months (e.g. in patients with malignancy) and the

pericardium has gradually stretched. The fluid, often measuring a litre or more, causes the

pericardium to sag, mimicking an old-fashioned water bottle sitting on the bench.

References

1. Walker HK, Hall WD, Hurst JW. Clinical methods, the history, physical, and

laboratory examinations. Butterworth-Heinemann. (1990) ISBN:040990077X. Read it at

Google Books - Find it at Amazon

Synonyms & Alternative Spellings

Synonyms or Alternative Spelling Include in Listings?

Water bottle configuration ✗

Water bottle heart

42

From the case: Pericardial effusion - water bottle sign

Modality: X-ray

43

From the case: Pericardial effusion

Modality: X-ray

44

From the

case: Pericardial effusion

Modality: X-ray

45

White pyramid sign

Dr Henry Knipe and Dr Mohammed Al Khader.O.Thabet et al.

Medullary pyramids of kidney can be seen normally on unenhanced CT scans as high-

attenuation structures and this is known as the white pyramid sign:

bilateral high-attenuation renal pyramids are an occasional incidental normal finding

unilateral appearance of white pyramids is subtle secondary sign suggestive of

contralateral urinary tract obstruction

References

1. Webb WR, Brant W, Major N. Fundamentals of Body Ct. Saunders. (2006)

ISBN:1416000305. Read it at Google Books - Find it at Amazon

2. Dogra VS, MacLennan GT. Genitourinary Radiology: Kidney, Bladder and Urethra.

Springer. (2012) ISBN:1848002459. Read it at Google Books - Find it at Amazon

3. Step by Step in Emergency Radiology. Jaypee Brothers Medical Publishers.

ISBN:818061803X. Read it at Google Books - Find it at Amazon

46

From the case: White pyramids

Modality: CT