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

1. Dr Tejas M Tamhane.
JRII, DEPT. OF RADIO-DIAGNOSIS

2. To quote Dr. Neuffer
“These are the things
Radiologists come up with
when they sit in the dark
too long…”

3. AIR CRESCENT SIGN
Sickle shaped lucency
partly surrounding a
mass in a pulmonary
cavity on x ray and
CT.
Classically in
ASPERGILLOMAS.

4. ANGEL WING OR BAT WING SIGN
Seen in pulmonary
edema which
involves perihilar
regions and spares
cortex of the lung

5. ANTEATER’S NOSE SIGN
On lateral view of
foot, elongated
anterior, superior
process of
calcaneous seen in
tarsal coalition.

6. APPLE CORE SIGN
Appearance of an
annular constricting
carcinoma of the bowel,
usually the colon, from
circumferential
involvement of the
lumen.

7. BAMBOO SPINE
Undulating contour
of spine caused by
bridging
syndesmophytes
seen in ankylosing
spondylitis.

8. BEVELED EDGE APPEARANCE
Asymmetric
erosion of the inner
and outer tables of
the skull usually
seen with
EOSINOPHILIC
GRANULOMA.

9. BLADE OF GRASS SIGN
Advancing wedge
shaped, osteolytic
margin of active
Paget disease of
bone. Seen in
diaphysis.
AKA FLAME SIGN.

10. BIRD OF PREY SIGN
Tapered barium column
seen in SIGMOID
VOLVULUS

11. BIRD’S BEAK SIGN
Irregularly
marginated tapering
of esophagus in
ACHALASIA.
AKA RAT TAIL
SIGN.

12. BOWLER HAT SIGN
Cup shaped filling
defect seen on air
contrast barium
enema that
represents POLYP
if it points towards
lumen.

13. BONE WITHIN BONE SIGN
Inner layer of cortical
new bone within an
existing bone seen with
OSTEOPETROSIS,
SICKLE CELL DISEASE.

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. 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. BULGING FISSURE SIGN
Bulging of usually
minor fissure from
heavy, exudative
pneumonia like
KLEBSIELLA.

17. BOUTONNIERE DEFORMITY
Hyperextension of
DIP Jt and flexion of
PIP Jt seen in
RHEUMATOID
ARTHRITIS.

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. CARMAN MENISCUS SIGN
Large gastric ulcer
seen on UGI convex
in towards the lumen
of the stomach, rolled
edges suggestive of
malignancy

20. CODMAN TRIANGLE
Triangular elevation of
periosteum from an
aggressive, usually
malignant, bone tumor
such as an
OSTEOSARCOMA.

21. COTTON WOOL APPEARANCE
Islands of poorly
marginated
sclerotic disease
surrounded by less
dense skull in
PAGETS DISEASE.

22. COFFEE BEAN SIGN
Dilated sigmoid
colon in SIGMOID
VOLVULUS
thought to resemble
giant coffee beans.

23. COBRA HEAD APPEARANCE
Rounded dilatation
of distal ureter,
surrounded by thin
lucent line, seen in
pts with
URETEROCELES.

24. COBBLESTONE APPEARANCE
GI alternating
normal and
denuded
mucosa from
ulceration, esp
in CROHN’S
DISEASE OF
COLON.

25. CHAMPAGNE GLASS SIGN
Squaring of the iliac
wings producing a
champagne glass
appearance of the
pelvic inlet seen in
ACHONDROPLASIA.

26. CRESCENT SIGN
Caused by:
LUQ Soft tissue mass
OR
Head of
intussusception in
distal transverse
colon

27. CONTINUOUS DIAPHRAGM SIGN
Visualisation of the entire
upper surface of
diaphragm from
PNEUMOMEDIASTINUM

28. CORKSCREW ESOPHAGUS
Constricted, twisted
lumen from
abnormal, tertiary
contractions seen in
DIFFUSE
ESOPHAGEAL
SPASM.

29. COCKADE SIGN
Intraosseous
calcaneal LIPOMA
with central
calcification
resembling the badge
generally worn upon
a hat.

30. CODFISH VERTEBRA
Biconcave appearance
of vertebral bodies
from avascular
necrosis resembling
vertebra of codfish.
Seen in SICKLE CELL
ANAEMIA.

31. DAVID LETTERMAN SIGN
Widening of
distance between
the scaphoid and
lunate >3mm on PA
view from ligament
disruption.
AKA TERRY
THOMAS SIGN

32. DOUBLE BUBBLE SIGN
Dilated stomach and
proximal duodenum
in newborn, typically
seen in DUODENAL
ATRESIA, MIDGUT
VOLVULUS OR
ANNULAR
PANCREAS.

33. DEEP SULCUS SIGN
Inferiorly depressed
costophrenic angle
from
PNEUMOTHORAX
seen on supine
radiograph of chest.

34. DROOPING LILY SIGN
Appearance of lower
pole calyces in a
duplicated collecting
system with non
functioning of upper
pole.

35. DRIPPING CANDLE WAX SIGN
Cortical hyperostosis on
one side of bone likened to
melting wax, seen in
MELORHEOSTOSIS.

36. DAGGER SIGN
Dense line caused
by ossification of
supraspinous and
interspinous
ligaments in
ANKYLOSING
SPONDYLITIS

37. EGGSHELL CALCIFICATION
Peripheral
calcification of
thoracic lymph
nodes, most often
seen in SILICOSIS
but also can be seen
in SARCOID.

38. EGG ON STRING SIGN
Narrowing of superior
mediastinum and
globular shape of
heart in neonates
with
TRANSPOSITION OF
GREAT ARTERIES.

39. FALLEN FRAGMENT SIGN
Small piece of bone
settles to dependent
portion of a
UNICAMERAL BONE
CYST from
pathological fracture.

40. FIG 3 SIGN
Seen in
COARCTATION OF
AORTA, dilated
LSCA, indentation of
coarct and post
stenotic aortic
dilatation form “3”

41. FOOTBALL SIGN
Oval shaped
lucency seen on
supine abdominal
radiographs in
LARGE
PNEUMOPERITON
EUM usually in
infants.

42. FISHOOKING OF URETER
J shaped appearance
of distal ureter from
enlargement of
prostate and
elevation of trigone
usually in BPH.

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. GOLDEN S SIGN
S shape caused by
edge of elevated
minor fissure and
hilar mass in RUL
ATELECTASIS.

45. GLOVED FINGER SIGN
Finger like projections
from hilum from
bronchial mucoid
impaction in
ALLERGIC
BRONCHOPULMON
ARY ASPERGILLOSIS
OR ASTHMA.

46. GULL WING SIGN
DIP jts showing
central erosions and
marginal osteophytes
in EROSIVE
OSTEOARTHRITIS.

47. HAIR ON END SIGN
Spiculated appearance
of elongated
trabeculae in widened
diploic space seen in
HEMOLYTIC
ANAEMIAS ESP
THALASEMIA.

48. HEEL PAD SIGN
Enlarged soft
tissue of heel
pad (>23mm)
that might
indicate
presence of
ACROMEGALY.

49. HONDA SIGN
Characteristic H
shape, similar to
carmaker’s logo of
bone radiotracer
uptake in sacrum
due to SACRAL
INSUFFICIENCY
FRACTURES.

50. HONEYCOMBING OF LUNGS
Clustered thick walled
cystic spaces
representing dilated
and thickened
bronchial walls, seen in
BRONCHIECTASIS
AND CYSTIC
FIBROSIS.

51. HILUM OVERLAY SIGN
Differentiates large
pulmonary artery
from hilar mass on
chest X ray, mass
superimposes on
vessels.

52. IVORY VERTEBRA
Dense white vertebral
body essentially of
normal shape, most
often from
OSTEOBLASTIC
PROSTATE, BREAST
CA METS, PAGETS
DISEASE.

53. JUXTAPHRENIC PEAK SIGN
Tent like projection of
the medial
hemidiaphragm seen
with UPPER and
sometimes MIDDLE
LOBE ATELECTASIS.

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. LEAD PIPE COLON SIGN
Rigid, ahaustral
appearance of
colon classically
seen with
CHRONIC
ULCERATIVE
COLITIS.

56. LICKED CANDY STICK SIGN
Tapered
appearance of
metacarpals,
phalanges and
clavicles seen
with
PSORIATIC
ARTHRITIS.

57. MERCEDES BENZ SIGN
Triradiate
radiolucent shadow
seen in Rt upper
quadrant of the
abdomen s/o
GALLSTONES.

58. NAPOLEAN HAT SIGN
Inverted hat like
appearance of L5
vertebra on frontal
view in SEVERE
ANTEROLISTHESIS
OF L5 ON S1.

59. OIL DROPLET SIGN
Multiple punched
out lytic defects
seen in MULTIPLE
MYELOMA.

60. PEAR SHAPED BLADDER
Shape of urinary
bladder from
extrinsic
compression from
excess pelvic fat,
fluid, blood, urine or
adenopathy.

61. PICTURE FRAMING VERTEBRA
Thickened cortex
of vertebral body
with PAGET’S
DISEASE
resembling a
picture frame.

62. PSEUDOTUMOR
AKA VANISHING
TUMOR, fluid in
fissure mostly seen
in CHF, which
vanishes with
reversal of failure.

63. PUTTY KIDNEY
"Putty kidney" – sacs
of casseous, necrotic
material (TB)
Autonephrectomy –
small, shrunken
kidney with dystrophic
calcification

64. RUGGER JERSEY SPINE
Sclerotic superior
and inferior
endplates of
vertebrae from
secondary
hyperparathyroidism
from renal disease.

65. RAT BITE SIGN
Sharply marginated,
overhanging bony
erosions usually
associated with
GOUTY ARTHRITIS.

66. RICE GRAIN CALCIFICATION
Elongated oval shaped,
soft tissue calcifications
of rice grain size seen
in CYSTICERCOSIS

67. SNOWMAN HEART SIGN
Dilated vertical vein
and SVC form head
of snowman in type 1
SUPRACARDIAC
TAPVC.

68. SWAN NECK DEFORMITY
Hyperextension of PIP
jt and flexion of DIP jt
seen in
RHEUMATOID
ARTHRITIS.

69. SILVER FORK DEFORMITY
Appearance of acutely
dorsally angulated
wrist from distal radius
# seen in COLLE’S #.

70. SNOWSTORM APPEARANCE
Innumerable small
pulmonary nodules
frequently associated
with metastatic CA
from thyroid.

71. STRING SIGN
Very thin luminal
contrast usually in
terminal ileum from
spasm and eventually
fibrosis seen in mostly
in CROHN’S DISEASE.

72. STEP LADDER APPEARANCE
Loops arrange
themselves from left
upper to right lower
quadrant in distal SBO

73. SUNBURST SIGN
Highly aggressive
spiculated reaction
indicating a
malignancy such as
OSTEOSARCOMA.

74. SALT AND PEPPER SKULL
Multiple small areas of
resorption of skull in
HYPERPARATHYROIDI
SM results in mottled
appearance like salt and
pepper.

75. THUMB PRINT SIGN
Indentation in
contrast or air filled
bowel lumen
caused by
submucosal
infiltration
resembling
thumbprint seen in
ISCHAEMIC
COLITIS.

76. THUMB SIGN
Enlarged
epiglottis in
EPIGLOTTITIS is
stubby like thumb
instead of its usual
thin fingerlike
projection.

77. WATERBOTTLE HEART SIGN
Globular shape
of heart from a
large
PERICARDIAL
EFFUSION.

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