Radiology Signs Flashcards
Chronic pancreatitis Chain of lakes sign
Sentinel clot sign
The sentinel clot sign is a useful CT finding for the evaluation of probable anatomic sites of haemorrhage.
On CT, acute clotted haemorrhage typically has high attenuation (45 to 70 HU), whereas surrounding areas of acute non-clotted haemorrhage or more chronic haemorrhage have either lower attenuation (30 to 45 HU) or fluid attenuation (0 to 10 HU).
This is the basis for the sentinel clot sign, areas of higher attenuation are likely to represent more acute clotted haemorrhage, and are therefore more likely to indicate the anatomic sites of haemorrhage.
Innumerable small punctate extravasations in a traumatised spleen following motor vehicle accident.
This angiographic appearance is often termed ‘Seurat spleen’ because of a likeness to the pointillistic artwork of French impressionist Georges Seurat (1859 - 1891).
“Gray weather, Grande Jatte” by Georges Seurat, painted 1888.
Case Discussion
Innumerable small punctate contrast extravasations in a traumatised spleen following motor vehicle accident. This angiographic appearance is often termed ‘Seurat spleen’ because of a likeness to the artwork of French impressionist Georges Seurat (1859 - 1891) who used a pointillistic technique to create an image out of tiny dots. Proximal splenic artery embolisation with coil was performed in this patient who went on to make an uneventful recovery from their splenic trauma.
The Martini glass sign describes the appearance of the globe in persistent hyperplastic primary vitreous (PHPV).
On MRI the retrolenticular tissue characteristic of this condition has a triangular shape, like that of a martini glass appearing as low T2 signal against the normal high T2 signal of the globe 1.
Persistent hyperplastic primary vitreous (PHPV), also known as the persistent fetal vasculature, refers to a rare congenital developmental malformation of the eye.
Clinical presentation
Clinically, this condition usually manifests as unilateral or bilateral leucocoria. Patients may also have poor vision, small eye (microphthalmia) and strabismus.
Pathology
It arises due to a failure of normal regression of the embryonic hyaloid vascular system. Normally, the primary vitreous forms around the 7th week of gestation and starts involuting around 20th week and has nearly always disappeared by birth. Persistent fetal vasculature in PHPV can lead to fibrosis, resulting in elongation of the ciliary processes, retinal detachment, and spontaneous cataracts.
Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 37964
Thickened diploe of the skull and ill-defined ‘fluffy’ sclerotic areas most pronounced in the frontal bone.
Case Discussion
The cotton wool appearance is a plain film sign on the lateral skull radiograph in Paget disease.
The appearances result from widening of the diploe of the skull with thickened, disorganised trabeculae.
Sclerotic ill-defined ‘‘patches’’ appear fluffy like cotton wool.
The hair on end sign refers to a radiographic appearance of the diploic space of the skull vault which results from a thickening of trabeculae as the diploic space expands. These trabeculae are perpendicular in orientation, interspersed by radiolucent marrow hyperplasia along with skull vault.
Case courtesy of Dr Mohammad Taghi Niknejad, Radiopaedia.org, rID: 21052
HI NEST
Hereditary Spherocytosis
Iron deficiency anaemia
Neuroblastoma
Enzyme deficiency, e.g. G-6-PD deficiency causing haemolytic anaemia
Sickle cell
Thallassemia
Wasp waist sign:
The wasp-waist sign is a radiographic appearance seen in patients with Klippel Feil syndrome. It results from fusion of the vertebral bodies such that the anteroposterior diameter at the level of the affected discovertebral joint is smaller than the diameter at the superior and inferior limits of the vertebrae adjacent to uninvolved discs.
Axial, fat-suppressed, T2-weighted MRI image shows the characteristic appearances of a midline dermoid cyst in the floor of mouth with a ‘‘sack of marbles’’ appearance (arrow) due to presence of fat globules (arrowheads) within the dermoid cyst.
Tornwaldt cysts commonly presents as an incidental finding during imaging investigations. It is asymptomatic with no gender predilection. In some instances it can be complicated by infection. It is usually located in the midline of the roof of the nasopharynx causing a midline bulge.
Spinnaker sail sign
- the spinnaker sail sign is the primary finding of vocal cord paralysis
- Paramedian position of the affected VC
- ballooning of the ipsilateral laryngeal ventricle
- anteromedial rotation of the arytenoid cartilage
- medially displaced and thickened aryepiglottic foldenlarged ipsilateral pyriform sinus
What sign is this and for which condition
Moulage sign and ceoliac disease
Loss of jejunal folds/mucosa
Citation, DOI and article data
The moulage sign is related to sprue, in particular coeliac disease. It occurs where there is a dilated jejunal loop with complete loss of jejunal folds 1. It is said to appear like a tube into which wax has been poured.
History and etymology
Moulage (French: casting/moulding) is the art of applying mock injuries to aid in the education of medical emergency teams. It was used as early as the renaissance when wax figures were used.
Triad of this condition
Associations
part of which spectrum
what is this sign?
point-down appearance of the anterior horns of the bilateral lateral ventricles
Septo-optic dysplasia (SOD)
- AKA
- de Morsier syndrome
- optic nerve hypoplasia
- absence of the septum pellucidum
- hypothalamic-pituitary dysfunction (2/3 of pts)
- part of the holoprosencephalyspectrum
- Associations:
- 50% a/w schizencephaly
- Types:
- No schizencephaly
- visual apparatus more severely affected
- hypothalamic-pituitary dysfunction present in 60-80% of patients
- may present as hypoglycaemia in the neonatal period
- small pituitary gland with hypoplastic or absent infundibulum
- ectopic posterior pituitary seen as a focus of T1 high signal intensity in the median eminence of hypothalamus
- olfactory bulbs may be absent (Kallmann syndrome)
- associated with schizencephaly
- optic apparatus less severely affected
- cortical anomalies:
- polymicrogyria,
- cortical dysplasia
- may be aetiologically different
- sometimes referred to as septo-optic dysplasia plus
- No schizencephaly
- In addition, a number of other associations are recognised including:
- rhombencephalosynapsis
- Chiari II malformation
- aqueductal stenosis
Selected image of coronal T2-weighted sequence showed the normal olfactory nerves (within the red cycles).
Selected image of coronal T2-weighted sequence showed point-down appearance of the anterior horns of the bilateral lateral ventricles (red arrows).
Selected image of sagittal T1-weighted sequence showed the ectopic posterior pituitary gland at the roof of the third ventricle (red circle).
Case Discussion
This is a case where most of the septo-optic dysplasia features are nicely demonstrated.
Hypoplastic optic nerves and chiasm, absence septum pellucidum with resultant typical configuration of the anterior horns of the lateral ventricles, along with ectopia of the posterior pituitary gland. On the other hand, the globes are intact and the olfactory bulbs are present with no evidence of associated parenchymal abnormality.
what sign is this?
what is the associated condition?
- Black turbinate sign
- acute fulminant invasive fungal sinusitis
- mostcommonly begins as mucosal inflammation around the middle tubrinate
- Nonenhancing hypointense turbinate
What sign is this?
EGG ON A STRING SIGN
Transposition of the great arteries (TGA)
Egg-on-a-string sign, also referred to as egg on its side, refers to the cardiomediastinal silhouette seen in transposition of the great arteries (TGA).
The heart appears globular due to an abnormal convexity of the right atrial border and left atrial enlargement and therefore appears like an egg.
The superior mediastinum appears narrow due to stress-induced thymic atrophy and hyperinflated lungs which give the picture of an egg suspended by a string on a chest radiograph, hence the name egg-on-a-string.
- https://radiopaedia.org/cases/43062/studies/46337?lang=gb&referrer=%2Farticles%2Fegg-on-a-string-sign-heart%3Flang%3Dgb%23image_list_item_19693757
- https://radiopaedia.org/articles/egg-on-a-string-sign-heart?lang=gb#image_list_item_19693757
What sign is this?
7 x ddx for this condition
7 x DDx Pericardial Effusion
WATER BOTTLE SIGN
- Transudate
- CHF
- AMI
- Post Op
- Autoimmune
- Renal Failure
- Infectious
- Viral
- Tumour
- Pericardial Mets
Case courtesy of Assoc Prof Frank Gaillard, Radiopaedia.org, rID: 7142
What is this condition?
What is the AKA of this condition?
What patients tend to get this?
What are the complications?
what is the sign?
- bulging fissure sign.
- Klebsiella pneumonia, also known as Friedländer pneumonia, refers to pneumonia resulting from an infection from the organism Klebsiella pneumoniae.
- Epidemiology
- There tends to be a higher prevalence in older patients with alcoholism and debilitated hospitalised patients 3.
- Pathology
- Klebsiella pneumoniae is among the most common Gram-negative bacteria encountered by physicians worldwide and accounts for 0.5-5.0% of all cases of pneumonia 2.
- Complications
- This organism can cause
- extensive pulmonary necrosis and
- frequent cavitation
- This organism can cause
- Radiographic features
- Plain radiograph
It is one of the causes that could be suspected when there is cavitatory pneumonia +/- a bulging fissure sign.
- Often there can be extensive lobar opacification with air bronchograms.
A helpful feature which may help to distinguish from pneumococcal pneumonia is that Klebsiella pneumonia develops cavitation in 30-50% of cases (in comparison, cavitation is rare in pneumococcal pneumonia). This occurs early and progresses quickly. Massive necrosis (pulmonary gangrene) is a recognised complication.
Extensive right upper lobe consolidation, with bulging of the horizontal fissure.
Sputum analysis grew Klebsiella pneumoniae.
Case Discussion
Klebsiella pneumoniae is a gram negative organism that usually affects people with alcoholism or chronic debilitating diseases (similar to other gram -ve pneumonias). On CXR, consolidation is lobar and resembles streptococcus pneumonia. Lobar expansion (e.g. bulging of the horizontal fissure in this case) is less common nowadays with modern antibiotic treatment. Also, lobar expansion is not specific for Klebsiella infection.
A helpful feature which may help to distinguish from pneumococcal pneumonia is that Klebsiella pneumonia develops cavitation in 30-50% of cases. This occurs early and progresses quickly. Massive necrosis (pulmonary gangrene) is a recognised complication. In comparison, cavitation is rare in pneumococcal pneumonia.
Asbestos:
4 pleural and 3 pulmonary findings
What sign is seen here?
- pleura
- pleural plaques
- diffuse thickening
- benign pleaural effusion
- pleural calc
- Lung
- intersitial fibrosis
- rounded atelectasis with commet tail sign
- Fibrous mass
The comet tail sign is a finding that can be seen on CT scans of the chest. It consists of a curvilinear opacity that extends from a subpleural “mass” toward the ipsilateral hilum. The comet tail sign is produced by the distortion of vessels and bronchi that lead to an adjacent area of round atelectasis, which is the mass 2. The bronchovascular bundles appear to be pulled into the mass and resemble a comet tail.
Adjacent pleural thickening is almost always seen and well demonstrated at CT. On administration of IV contrast, homogeneous enhancement is seen. This, however may also be seen in carcinomas and hence cannot be used as a differentiating feature.
Rounded Atelectasis. Axial enhanced CT scan of the chest shows a nodular-area of increased density (blue arrow), associated with pleural thickening and pleural plaques (yellow arrows) consistent with asbestos- related pleural disease. Red arrow point to “comet tail” density that surrounds rounded atelectasis
Case courtesy of The Radswiki, Radiopaedia.org, rID: 11894
http://learningradiology.com/notes/chestnotes/roundatelectasispage.htm
5 RADIOGRAPHIC FEATURES/Signs OF PE on XRAY
- Fleishner sign
- the increased diameter of the PA (16mm)
- seen in acute PE.
- Disappears in a few days
- Hampton hump
- triangular peripheral cone of infarct.
- Which is blood in the 2ndary pulmonary lobule
- should reduce in size on subsequent films
- Westermark Sign
- localized oligaemia
- wedge-shaped opacity
- pulmonary edema
- atelectasis
- pleural effusion
- Increased RA or RV
- cor pulmonale
RAD FEATURES of BRONCHIECTASIS
3 on xray
4 on HRCT
What sign is this?
- CXR
- tramline horizontal, parallel lines
- bronchial wlal thickening
- atelectasis
- HRCT
- Conspicuous bronchi seen in out 1/3 of lung
- bronchi appear larger than accompanying vessels
- Bronchial walls thickened
-
Signet ring sign
- Focally thickened bronchial wall adjacent to PA branch
Case courtesy of The Radswiki, Radiopaedia.org, rID: 11258
The signet ring sign is seen in bronchiectasis when the dilated bronchus and accompanying pulmonary artery branch are seen in cross-section. The bronchus and artery should be the same size, whereas in bronchiectasis, the bronchus is markedly dilated.
What are the 6 radiographic features of uretal duplication?
What sign is this?
Radiographic Features (Lebowitz) ( Fig. 11.39 )
- Increased distance from top of nephrogram to collecting system: hydronephrotic upper pole moiety causes mass effect (1)
- Abnormal axis of collecting system (2)
- Concave upper border of renal pelvis (3)
- Diminished number of calyces compared with normal side; drooping lily sign (4)
- Lateral displacement of kidney and ureter (5)
- Spiral course of ureter (6)
- Filling defect in the bladder (ureterocele)
Case courtesy of Dr Mohammad Taghi Niknejad, Radiopaedia.org, rID: 54354
SIGN
What sign is this and what does it indicate?
The drooping lily sign
Left sided duplicated collecting system with the upper moiety obstruction, and non-functioning. It displaces the lower pole moiety inferiorly, mimicking the appearance of a drooping lily.
The drooping lily sign refers to the inferolateral displacement of the opacified lower pole moiety due to an obstructed (and unopacified) upper pole moiety in duplicated collecting system.
Case courtesy of Dr Mohammad Taghi Niknejad, Radiopaedia.org, rID: 54354
SPOTTED NEPHROGRAM
Figure 5A
A late arterial phase from an aorto- gram shows bilateral spotted neph- rognams in a patient with polyartenitis nodosa.
Figure 5B
This is a late phase from a selective renal arteniogram in the same patient; it demonstrates occlusion of multiple peripheral vessels with cortical irregu- lanity.
https://pubs.rsna.org/doi/pdf/10.1148/radiographics.6.6.3685518
What are the signs of RVT on IVP?
What sign is this?
Delayed nephrogram
IVP:
- little opacification,
- prolonged nephrogram,
- striated nephrogram (stasis in collecting tubules);
- intrarenal collecting system is stretched and compressed by edema
https://pubs.rsna.org/doi/pdf/10.1148/radiographics.6.6.3685518
Hoffman-Rigler SIGN
Case courtesy of Dr Vincent Tatco, Radiopaedia.org, rID: 44892
Annotated image demonstrating the Hoffman-Rigler sign. Left ventricular enlargement is suggested on lateral chest radiograph if the distance (D) between the LV border border and the posterior border of IVC is more than 1.8 cm at a level 2 cm above the intersection of diaphragm and IVC.
Case Discussion
This case demonstrates the Hoffman-Rigler sign of left ventricular enlargement on lateral chest radiograph.
Annotated image demonstrating the borders of the left ventricle (LV) and inferior vena cava (IVC) on the lateral chest radiograph.
The lower posterior heart border is displaced posteriorly reflective of left ventricular enlargement.
