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Dr Tejas M Tamhane.
JRII, DEPT. OF RADIO-DIAGNOSIS
To quote Dr. Neuffer
“These are the things
Radiologists come up with
when they sit in the dark
too long…”
AIR CRESCENT SIGN
Sickle shaped lucency
partly surrounding a
mass in a pulmonary
cavity on x ray and
CT.
Classically in
AS...
ANGEL WING OR BAT WING SIGN
Seen in pulmonary
edema which
involves perihilar
regions and spares
cortex of the lung
ANTEATER’S NOSE SIGN
On lateral view of
foot, elongated
anterior, superior
process of
calcaneous seen in
tarsal coalition.
APPLE CORE SIGN
Appearance of an
annular constricting
carcinoma of the bowel,
usually the colon, from
circumferential
invo...
BAMBOO SPINE
Undulating contour
of spine caused by
bridging
syndesmophytes
seen in ankylosing
spondylitis.
BEVELED EDGE APPEARANCE
Asymmetric
erosion of the inner
and outer tables of
the skull usually
seen with
EOSINOPHILIC
GRANU...
BLADE OF GRASS SIGN
Advancing wedge
shaped, osteolytic
margin of active
Paget disease of
bone. Seen in
diaphysis.
AKA FLAM...
BIRD OF PREY SIGN
Tapered barium column
seen in SIGMOID
VOLVULUS
BIRD’S BEAK SIGN
Irregularly
marginated tapering
of esophagus in
ACHALASIA.
AKA RAT TAIL
SIGN.
BOWLER HAT SIGN
Cup shaped filling
defect seen on air
contrast barium
enema that
represents POLYP
if it points towards
lum...
BONE WITHIN BONE SIGN
Inner layer of cortical
new bone within an
existing bone seen with
OSTEOPETROSIS,
SICKLE CELL DISEAS...
BOOT SHAPED HEART
Typical shape of heart
seen in TETRALOGY OF
FALLOT.
Includes:-
1.Pulmonary infundibular
stenosis.
2.Over...
BOX SHAPED HEART
Squared off
appearance of the
heart in EBSTEIN’S
ANOMALY due to
large right atrium
and dilated Rt.
Ventri...
BULGING FISSURE SIGN
Bulging of usually
minor fissure from
heavy, exudative
pneumonia like
KLEBSIELLA.
BOUTONNIERE DEFORMITY
Hyperextension of
DIP Jt and flexion of
PIP Jt seen in
RHEUMATOID
ARTHRITIS.
COLON CUT OFF SIGN
Abrupt cutoff of colonic
gas column at the
splenic flexure (arrow).
The colon is usually
decompressed b...
CARMAN MENISCUS SIGN
Large gastric ulcer
seen on UGI convex
in towards the lumen
of the stomach, rolled
edges suggestive o...
CODMAN TRIANGLE
Triangular elevation of
periosteum from an
aggressive, usually
malignant, bone tumor
such as an
OSTEOSARCO...
COTTON WOOL APPEARANCE
Islands of poorly
marginated
sclerotic disease
surrounded by less
dense skull in
PAGETS DISEASE.
COFFEE BEAN SIGN
Dilated sigmoid
colon in SIGMOID
VOLVULUS
thought to resemble
giant coffee beans.
COBRA HEAD APPEARANCE
Rounded dilatation
of distal ureter,
surrounded by thin
lucent line, seen in
pts with
URETEROCELES.
COBBLESTONE APPEARANCE
GI alternating
normal and
denuded
mucosa from
ulceration, esp
in CROHN’S
DISEASE OF
COLON.
CHAMPAGNE GLASS SIGN
Squaring of the iliac
wings producing a
champagne glass
appearance of the
pelvic inlet seen in
ACHOND...
CRESCENT SIGN
Caused by:
LUQ Soft tissue mass
OR
Head of
intussusception in
distal transverse
colon
CONTINUOUS DIAPHRAGM SIGN
Visualisation of the entire
upper surface of
diaphragm from
PNEUMOMEDIASTINUM
CORKSCREW ESOPHAGUS
Constricted, twisted
lumen from
abnormal, tertiary
contractions seen in
DIFFUSE
ESOPHAGEAL
SPASM.
COCKADE SIGN
Intraosseous
calcaneal LIPOMA
with central
calcification
resembling the badge
generally worn upon
a hat.
CODFISH VERTEBRA
Biconcave appearance
of vertebral bodies
from avascular
necrosis resembling
vertebra of codfish.
Seen in ...
DAVID LETTERMAN SIGN
Widening of
distance between
the scaphoid and
lunate >3mm on PA
view from ligament
disruption.
AKA TE...
DOUBLE BUBBLE SIGN
Dilated stomach and
proximal duodenum
in newborn, typically
seen in DUODENAL
ATRESIA, MIDGUT
VOLVULUS O...
DEEP SULCUS SIGN
Inferiorly depressed
costophrenic angle
from
PNEUMOTHORAX
seen on supine
radiograph of chest.
DROOPING LILY SIGN
Appearance of lower
pole calyces in a
duplicated collecting
system with non
functioning of upper
pole.
DRIPPING CANDLE WAX SIGN
Cortical hyperostosis on
one side of bone likened to
melting wax, seen in
MELORHEOSTOSIS.
DAGGER SIGN
Dense line caused
by ossification of
supraspinous and
interspinous
ligaments in
ANKYLOSING
SPONDYLITIS
EGGSHELL CALCIFICATION
Peripheral
calcification of
thoracic lymph
nodes, most often
seen in SILICOSIS
but also can be seen...
EGG ON STRING SIGN
Narrowing of superior
mediastinum and
globular shape of
heart in neonates
with
TRANSPOSITION OF
GREAT A...
FALLEN FRAGMENT SIGN
Small piece of bone
settles to dependent
portion of a
UNICAMERAL BONE
CYST from
pathological fracture.
FIG 3 SIGN
Seen in
COARCTATION OF
AORTA, dilated
LSCA, indentation of
coarct and post
stenotic aortic
dilatation form “3”
FOOTBALL SIGN
Oval shaped
lucency seen on
supine abdominal
radiographs in
LARGE
PNEUMOPERITON
EUM usually in
infants.
FISHOOKING OF URETER
J shaped appearance
of distal ureter from
enlargement of
prostate and
elevation of trigone
usually in...
FISHMOUTHING OF VERTEBRA
Biconcave appearance
of the disc spaces in
SICKLE CELL DISEASE
from avascular necrosis
of the ver...
GOLDEN S SIGN
S shape caused by
edge of elevated
minor fissure and
hilar mass in RUL
ATELECTASIS.
GLOVED FINGER SIGN
Finger like projections
from hilum from
bronchial mucoid
impaction in
ALLERGIC
BRONCHOPULMON
ARY ASPERG...
GULL WING SIGN
DIP jts showing
central erosions and
marginal osteophytes
in EROSIVE
OSTEOARTHRITIS.
HAIR ON END SIGN
Spiculated appearance
of elongated
trabeculae in widened
diploic space seen in
HEMOLYTIC
ANAEMIAS ESP
THA...
HEEL PAD SIGN
Enlarged soft
tissue of heel
pad (>23mm)
that might
indicate
presence of
ACROMEGALY.
HONDA SIGN
Characteristic H
shape, similar to
carmaker’s logo of
bone radiotracer
uptake in sacrum
due to SACRAL
INSUFFICI...
HONEYCOMBING OF LUNGS
Clustered thick walled
cystic spaces
representing dilated
and thickened
bronchial walls, seen in
BRO...
HILUM OVERLAY SIGN
Differentiates large
pulmonary artery
from hilar mass on
chest X ray, mass
superimposes on
vessels.
IVORY VERTEBRA
Dense white vertebral
body essentially of
normal shape, most
often from
OSTEOBLASTIC
PROSTATE, BREAST
CA ME...
JUXTAPHRENIC PEAK SIGN
Tent like projection of
the medial
hemidiaphragm seen
with UPPER and
sometimes MIDDLE
LOBE ATELECTA...
J SHAPED SELLA
Sella extends under
anterior clinoid
process and looks
like J on side, seen in
NORMALS,
HYDROCEPHALUS
OR OP...
LEAD PIPE COLON SIGN
Rigid, ahaustral
appearance of
colon classically
seen with
CHRONIC
ULCERATIVE
COLITIS.
LICKED CANDY STICK SIGN
Tapered
appearance of
metacarpals,
phalanges and
clavicles seen
with
PSORIATIC
ARTHRITIS.
MERCEDES BENZ SIGN
Triradiate
radiolucent shadow
seen in Rt upper
quadrant of the
abdomen s/o
GALLSTONES.
NAPOLEAN HAT SIGN
Inverted hat like
appearance of L5
vertebra on frontal
view in SEVERE
ANTEROLISTHESIS
OF L5 ON S1.
OIL DROPLET SIGN
Multiple punched
out lytic defects
seen in MULTIPLE
MYELOMA.
PEAR SHAPED BLADDER
Shape of urinary
bladder from
extrinsic
compression from
excess pelvic fat,
fluid, blood, urine or
ade...
PICTURE FRAMING VERTEBRA
Thickened cortex
of vertebral body
with PAGET’S
DISEASE
resembling a
picture frame.
PSEUDOTUMOR
AKA VANISHING
TUMOR, fluid in
fissure mostly seen
in CHF, which
vanishes with
reversal of failure.
PUTTY KIDNEY
"Putty kidney" – sacs
of casseous, necrotic
material (TB)
Autonephrectomy –
small, shrunken
kidney with dyst...
RUGGER JERSEY SPINE
Sclerotic superior
and inferior
endplates of
vertebrae from
secondary
hyperparathyroidism
from renal d...
RAT BITE SIGN
Sharply marginated,
overhanging bony
erosions usually
associated with
GOUTY ARTHRITIS.
RICE GRAIN CALCIFICATION
Elongated oval shaped,
soft tissue calcifications
of rice grain size seen
in CYSTICERCOSIS
SNOWMAN HEART SIGN
Dilated vertical vein
and SVC form head
of snowman in type 1
SUPRACARDIAC
TAPVC.
SWAN NECK DEFORMITY
Hyperextension of PIP
jt and flexion of DIP jt
seen in
RHEUMATOID
ARTHRITIS.
SILVER FORK DEFORMITY
Appearance of acutely
dorsally angulated
wrist from distal radius
# seen in COLLE’S #.
SNOWSTORM APPEARANCE
Innumerable small
pulmonary nodules
frequently associated
with metastatic CA
from thyroid.
STRING SIGN
Very thin luminal
contrast usually in
terminal ileum from
spasm and eventually
fibrosis seen in mostly
in CROH...
STEP LADDER APPEARANCE
Loops arrange
themselves from left
upper to right lower
quadrant in distal SBO
SUNBURST SIGN
Highly aggressive
spiculated reaction
indicating a
malignancy such as
OSTEOSARCOMA.
SALT AND PEPPER SKULL
Multiple small areas of
resorption of skull in
HYPERPARATHYROIDI
SM results in mottled
appearance li...
THUMB PRINT SIGN
Indentation in
contrast or air filled
bowel lumen
caused by
submucosal
infiltration
resembling
thumbprin...
THUMB SIGN
Enlarged
epiglottis in
EPIGLOTTITIS is
stubby like thumb
instead of its usual
thin fingerlike
projection.
WATERBOTTLE HEART SIGN
Globular shape
of heart from a
large
PERICARDIAL
EFFUSION.
THANK YOU!!
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Radiology signs

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This presentation describes various signs in the field of Radiology which are characteristic of particular pathology.

Published in: Health & Medicine

Radiology signs

  1. 1. Dr Tejas M Tamhane. JRII, DEPT. OF RADIO-DIAGNOSIS
  2. 2. To quote Dr. Neuffer “These are the things Radiologists come up with when they sit in the dark too long…”
  3. 3. AIR CRESCENT SIGN Sickle shaped lucency partly surrounding a mass in a pulmonary cavity on x ray and CT. Classically in ASPERGILLOMAS.
  4. 4. ANGEL WING OR BAT WING SIGN Seen in pulmonary edema which involves perihilar regions and spares cortex of the lung
  5. 5. ANTEATER’S NOSE SIGN On lateral view of foot, elongated anterior, superior process of calcaneous seen in tarsal coalition.
  6. 6. APPLE CORE SIGN Appearance of an annular constricting carcinoma of the bowel, usually the colon, from circumferential involvement of the lumen.
  7. 7. BAMBOO SPINE Undulating contour of spine caused by bridging syndesmophytes seen in ankylosing spondylitis.
  8. 8. BEVELED EDGE APPEARANCE Asymmetric erosion of the inner and outer tables of the skull usually seen with EOSINOPHILIC GRANULOMA.
  9. 9. BLADE OF GRASS SIGN Advancing wedge shaped, osteolytic margin of active Paget disease of bone. Seen in diaphysis. AKA FLAME SIGN.
  10. 10. BIRD OF PREY SIGN Tapered barium column seen in SIGMOID VOLVULUS
  11. 11. BIRD’S BEAK SIGN Irregularly marginated tapering of esophagus in ACHALASIA. AKA RAT TAIL SIGN.
  12. 12. BOWLER HAT SIGN Cup shaped filling defect seen on air contrast barium enema that represents POLYP if it points towards lumen.
  13. 13. BONE WITHIN BONE SIGN Inner layer of cortical new bone within an existing bone seen with OSTEOPETROSIS, SICKLE CELL DISEASE.
  14. 14. BOOT SHAPED HEART Typical shape of heart seen in TETRALOGY OF FALLOT. Includes:- 1.Pulmonary infundibular stenosis. 2.Overriding aorta. 3.VSD 4.RVH
  15. 15. BOX SHAPED HEART Squared off appearance of the heart in EBSTEIN’S ANOMALY due to large right atrium and dilated Rt. Ventricular outflow tract
  16. 16. BULGING FISSURE SIGN Bulging of usually minor fissure from heavy, exudative pneumonia like KLEBSIELLA.
  17. 17. BOUTONNIERE DEFORMITY Hyperextension of DIP Jt and flexion of PIP Jt seen in RHEUMATOID ARTHRITIS.
  18. 18. COLON CUT OFF SIGN Abrupt cutoff of colonic gas column at the splenic flexure (arrow). The colon is usually decompressed beyond this point. Seen in ACUTE PANCREATITIS
  19. 19. CARMAN MENISCUS SIGN Large gastric ulcer seen on UGI convex in towards the lumen of the stomach, rolled edges suggestive of malignancy
  20. 20. CODMAN TRIANGLE Triangular elevation of periosteum from an aggressive, usually malignant, bone tumor such as an OSTEOSARCOMA.
  21. 21. COTTON WOOL APPEARANCE Islands of poorly marginated sclerotic disease surrounded by less dense skull in PAGETS DISEASE.
  22. 22. COFFEE BEAN SIGN Dilated sigmoid colon in SIGMOID VOLVULUS thought to resemble giant coffee beans.
  23. 23. COBRA HEAD APPEARANCE Rounded dilatation of distal ureter, surrounded by thin lucent line, seen in pts with URETEROCELES.
  24. 24. COBBLESTONE APPEARANCE GI alternating normal and denuded mucosa from ulceration, esp in CROHN’S DISEASE OF COLON.
  25. 25. CHAMPAGNE GLASS SIGN Squaring of the iliac wings producing a champagne glass appearance of the pelvic inlet seen in ACHONDROPLASIA.
  26. 26. CRESCENT SIGN Caused by: LUQ Soft tissue mass OR Head of intussusception in distal transverse colon
  27. 27. CONTINUOUS DIAPHRAGM SIGN Visualisation of the entire upper surface of diaphragm from PNEUMOMEDIASTINUM
  28. 28. CORKSCREW ESOPHAGUS Constricted, twisted lumen from abnormal, tertiary contractions seen in DIFFUSE ESOPHAGEAL SPASM.
  29. 29. COCKADE SIGN Intraosseous calcaneal LIPOMA with central calcification resembling the badge generally worn upon a hat.
  30. 30. CODFISH VERTEBRA Biconcave appearance of vertebral bodies from avascular necrosis resembling vertebra of codfish. Seen in SICKLE CELL ANAEMIA.
  31. 31. DAVID LETTERMAN SIGN Widening of distance between the scaphoid and lunate >3mm on PA view from ligament disruption. AKA TERRY THOMAS SIGN
  32. 32. DOUBLE BUBBLE SIGN Dilated stomach and proximal duodenum in newborn, typically seen in DUODENAL ATRESIA, MIDGUT VOLVULUS OR ANNULAR PANCREAS.
  33. 33. DEEP SULCUS SIGN Inferiorly depressed costophrenic angle from PNEUMOTHORAX seen on supine radiograph of chest.
  34. 34. DROOPING LILY SIGN Appearance of lower pole calyces in a duplicated collecting system with non functioning of upper pole.
  35. 35. DRIPPING CANDLE WAX SIGN Cortical hyperostosis on one side of bone likened to melting wax, seen in MELORHEOSTOSIS.
  36. 36. DAGGER SIGN Dense line caused by ossification of supraspinous and interspinous ligaments in ANKYLOSING SPONDYLITIS
  37. 37. EGGSHELL CALCIFICATION Peripheral calcification of thoracic lymph nodes, most often seen in SILICOSIS but also can be seen in SARCOID.
  38. 38. EGG ON STRING SIGN Narrowing of superior mediastinum and globular shape of heart in neonates with TRANSPOSITION OF GREAT ARTERIES.
  39. 39. FALLEN FRAGMENT SIGN Small piece of bone settles to dependent portion of a UNICAMERAL BONE CYST from pathological fracture.
  40. 40. FIG 3 SIGN Seen in COARCTATION OF AORTA, dilated LSCA, indentation of coarct and post stenotic aortic dilatation form “3”
  41. 41. FOOTBALL SIGN Oval shaped lucency seen on supine abdominal radiographs in LARGE PNEUMOPERITON EUM usually in infants.
  42. 42. FISHOOKING OF URETER J shaped appearance of distal ureter from enlargement of prostate and elevation of trigone usually in BPH.
  43. 43. FISHMOUTHING OF VERTEBRA Biconcave appearance of the disc spaces in SICKLE CELL DISEASE from avascular necrosis of the vertebral endplates resembling fish mouth.
  44. 44. GOLDEN S SIGN S shape caused by edge of elevated minor fissure and hilar mass in RUL ATELECTASIS.
  45. 45. GLOVED FINGER SIGN Finger like projections from hilum from bronchial mucoid impaction in ALLERGIC BRONCHOPULMON ARY ASPERGILLOSIS OR ASTHMA.
  46. 46. GULL WING SIGN DIP jts showing central erosions and marginal osteophytes in EROSIVE OSTEOARTHRITIS.
  47. 47. HAIR ON END SIGN Spiculated appearance of elongated trabeculae in widened diploic space seen in HEMOLYTIC ANAEMIAS ESP THALASEMIA.
  48. 48. HEEL PAD SIGN Enlarged soft tissue of heel pad (>23mm) that might indicate presence of ACROMEGALY.
  49. 49. HONDA SIGN Characteristic H shape, similar to carmaker’s logo of bone radiotracer uptake in sacrum due to SACRAL INSUFFICIENCY FRACTURES.
  50. 50. HONEYCOMBING OF LUNGS Clustered thick walled cystic spaces representing dilated and thickened bronchial walls, seen in BRONCHIECTASIS AND CYSTIC FIBROSIS.
  51. 51. HILUM OVERLAY SIGN Differentiates large pulmonary artery from hilar mass on chest X ray, mass superimposes on vessels.
  52. 52. IVORY VERTEBRA Dense white vertebral body essentially of normal shape, most often from OSTEOBLASTIC PROSTATE, BREAST CA METS, PAGETS DISEASE.
  53. 53. JUXTAPHRENIC PEAK SIGN Tent like projection of the medial hemidiaphragm seen with UPPER and sometimes MIDDLE LOBE ATELECTASIS.
  54. 54. J SHAPED SELLA Sella extends under anterior clinoid process and looks like J on side, seen in NORMALS, HYDROCEPHALUS OR OPTIC CHIASM GLIOMA
  55. 55. LEAD PIPE COLON SIGN Rigid, ahaustral appearance of colon classically seen with CHRONIC ULCERATIVE COLITIS.
  56. 56. LICKED CANDY STICK SIGN Tapered appearance of metacarpals, phalanges and clavicles seen with PSORIATIC ARTHRITIS.
  57. 57. MERCEDES BENZ SIGN Triradiate radiolucent shadow seen in Rt upper quadrant of the abdomen s/o GALLSTONES.
  58. 58. NAPOLEAN HAT SIGN Inverted hat like appearance of L5 vertebra on frontal view in SEVERE ANTEROLISTHESIS OF L5 ON S1.
  59. 59. OIL DROPLET SIGN Multiple punched out lytic defects seen in MULTIPLE MYELOMA.
  60. 60. PEAR SHAPED BLADDER Shape of urinary bladder from extrinsic compression from excess pelvic fat, fluid, blood, urine or adenopathy.
  61. 61. PICTURE FRAMING VERTEBRA Thickened cortex of vertebral body with PAGET’S DISEASE resembling a picture frame.
  62. 62. PSEUDOTUMOR AKA VANISHING TUMOR, fluid in fissure mostly seen in CHF, which vanishes with reversal of failure.
  63. 63. PUTTY KIDNEY "Putty kidney" – sacs of casseous, necrotic material (TB) Autonephrectomy – small, shrunken kidney with dystrophic calcification
  64. 64. RUGGER JERSEY SPINE Sclerotic superior and inferior endplates of vertebrae from secondary hyperparathyroidism from renal disease.
  65. 65. RAT BITE SIGN Sharply marginated, overhanging bony erosions usually associated with GOUTY ARTHRITIS.
  66. 66. RICE GRAIN CALCIFICATION Elongated oval shaped, soft tissue calcifications of rice grain size seen in CYSTICERCOSIS
  67. 67. SNOWMAN HEART SIGN Dilated vertical vein and SVC form head of snowman in type 1 SUPRACARDIAC TAPVC.
  68. 68. SWAN NECK DEFORMITY Hyperextension of PIP jt and flexion of DIP jt seen in RHEUMATOID ARTHRITIS.
  69. 69. SILVER FORK DEFORMITY Appearance of acutely dorsally angulated wrist from distal radius # seen in COLLE’S #.
  70. 70. SNOWSTORM APPEARANCE Innumerable small pulmonary nodules frequently associated with metastatic CA from thyroid.
  71. 71. STRING SIGN Very thin luminal contrast usually in terminal ileum from spasm and eventually fibrosis seen in mostly in CROHN’S DISEASE.
  72. 72. STEP LADDER APPEARANCE Loops arrange themselves from left upper to right lower quadrant in distal SBO
  73. 73. SUNBURST SIGN Highly aggressive spiculated reaction indicating a malignancy such as OSTEOSARCOMA.
  74. 74. SALT AND PEPPER SKULL Multiple small areas of resorption of skull in HYPERPARATHYROIDI SM results in mottled appearance like salt and pepper.
  75. 75. THUMB PRINT SIGN Indentation in contrast or air filled bowel lumen caused by submucosal infiltration resembling thumbprint seen in ISCHAEMIC COLITIS.
  76. 76. THUMB SIGN Enlarged epiglottis in EPIGLOTTITIS is stubby like thumb instead of its usual thin fingerlike projection.
  77. 77. WATERBOTTLE HEART SIGN Globular shape of heart from a large PERICARDIAL EFFUSION.
  78. 78. THANK YOU!!

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