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Classic Radiology Signs

Classic Radiology Signs

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Published by: Jui DirDap on Aug 19, 2011
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Classic Radiology Signs

These classic signs are listed in alphabetical order and can be found listed in various texts. The list here is a compilation from Dr. Smoger, S. Quazi, and from Michael E. Mulligan's Classic Radiologic Signs: An Atlas and History, available through the Department. Images of the listed signs can be found in the text. Apple Core lesion ²signifies annular carcinomas of the colon²looks like an apple core or napkin ring(see below) due to circumferential narrowing of the lumen, noted on contrast studies.

Bamboo Spine ²fused spinal segments with their syndesmophytes look, on radiographs, similar to bamboo stalks²classically associated with ankylosing spondylitis.

Bird's Beak² noted on Upper GI with contrast, a dilated upper/middle esophagus with an abrupt taper to exceptionally narrowed lumen, typical of achalasia.

Boot-shaped Heart ²due to RVH, the LV is lifted above the edge of the diaphragm, forming the ³toe´ of the boot. Classic for Tetralogy of Fallot.

Bat's Wing/Butterfly ²this appearance on CXR is classically associated with CHF and resultant pulmonary edema.

Cobblestone appearance² this sign is produced on barium studies due to ulcerative pockets, usually in the terminal ileum, indicative of Crohn's.

Codman's Triangle ²a triangle on plain film of extremities that signifies reactive bone, classically associated with osteosarcoma, or other infectious/hemorrhagic process that causes periosteal elevation.

Coin lesion² solitary pulmonary nodule; may be cancer or granuloma.

with loss of haustra²UC. Sail sign ²fat pad noted on plain film. Stepladder appearance ²distended bowel loops. Ground glass² a ³white-out´ on CXR. the lumbar vertebrae look like a Scottish terrier. or Paget's. indicative of shoulder disclocation. classically PE.g. ie pneumonia. Egg-on-a-string² a large. usually SBO. Rachitic Rosary ²this is a ³string of beads´ appearance on x-ray. thick-walled cystic spaces.Cookie Cutter lesions² metastatic lesions to bone cortex. often indicative of obstruction. Scotty dog(collar) ²on posterior oblique. e. Crescent sign² classic sign of avascular necrosis. Honeycomb lung² used to describe any pathologic process that causes radiographic appearance of multiple small. a thickening of costochondral margins that is noted in Ricketts(Vit. slightly irregular shadow in narrowed lumen of ileum. and a break(a collar) noted there indicates spondylolysis. D Deficiency). The neck is the pars interarticularis. Napkin Ring sign² see Apple core lesion above. Lead pipe sign² classic narrowing of bowel lumen. TB. usually PCP pneumonia or ARDS. ovoid-shaped heart on newborn CXR. etc. pathology identical. String sign ²thin. suggestive of Crohn's. usually near pleural edges. classically signifying complete transposition of the great vessels with intact ventricular septum. . Silhouette sign ²obliteration of cardiovascular silhouette due to adjacent disease. femoral head. pulmonary fibrosis. Onion-skinning ²layered look of periosteum in Ewing's Sarcoma. Hampton's Hump² a peripheral triangle. but lumen more narrowed.

Small Bowel Obstruction y y General considerations o Small bowel obstruction. Westermark's sign ²abrupt end to a pulmonary vessel. or within bony structures. the most common cause of a mechanical small bowel obstruction are adhesions related to prior surgery (60%)  The most common prior surgeries associated with a subsequent SBO include appendectomy.Sunburst appearance²³clouds.  Vomiting may release some of the proximal bowel contents and reduce the amount of proximal dilation o The bowel hyperperistalses o Bowel distal to the point of obstruction (i. an enlarged epiglottis appears as a ³thumb´² epiglottitis. colorectal surgery and gynecologic surgery  Bowel may become kinked under an adhesion  The obstruction is frequently partial or intermittent o Hernias  Most often femoral or inguinal o Intussusception o Volvulus o Tumor. Thumb(print) sign ²on lateral c-spine. signifying oligemia or PE. clumps. indicative of osteosarcoma. as the term is used here. colon and sometimes distal small bowel) empties over time o Strangulation of the bowel may result from vascular compromise of the affected loops and is a cause of increased mortality Causes o Overwhelmingly. is due to physical and organic changes which produce mechanical obstruction to the passage of the bowel contents somewhere in the small bowel o The bowel proximal to the point of obstruction dilates with swallowed air and secreted fluid.e. either primary or metastatic o Wall lesions such as leiomyomas or strictures o Crohn¶s disease . and consolidated rays´ of tissue emanating from bone cortex.

or disproportionately smaller amount of. usually at the ileocecal valve) Clinical findings o Abdominal pain and distension  Most marked in patients with distal SBO although its onset in distal obstructions is later in the course of the disease than in proximal obstruction  Typically colicky in nature and progressively worsening over time o Nausea o Vomiting  An earlier sign of a proximal than a distal obstruction  Fluid and electrolyte imbalances from vomiting increase mortality o Constipation o History of prior abdominal or pelvic surgery o Bowel sounds are hyperactive and high-pitched  Absence of bowel sounds may indicate bowel ischemia or peritonitis Imaging findings o Conventional radiography is the study of first choice  Loops proximal to the point of obstruction will become dilated and fluid-filled y Usually greater than 2. especially the rectosigmoid  Loops of small bowel may arrange themselves in a step-ladder configuration from the left upper to the right lower quadrant in a distal SBO  Mostly fluid-filled loops of bowel may demonstrate a string-of-beads sign caused by the small amount of visible air in those loops .y y o Foreign bodies o Gallstones  Such as in gallstone ileus (which is actually a mechanical obstruction.5-3 cm in size  Differential height of air-fluid levels in the same loop of small bowel no longer considered reliable sign of mechanical SBO  Absence of. gas in the colon.

their presence can be inferred by a rapid change in bowel caliber without any other causes of obstruction (e. click here o CT may demonstrate the site and cause of the obstruction  Dilated and fluid-filled loops of small bowel proximal to the obstruction and collapsed loops of small bowel and/or colon distal to the obstruction  Small bowel feces sign is seen in SBO because of the intermixing of air with material that is static in obstructed small bowel. The small bowel is disproportionately dilated compared the the large bowel which is collapsed. hernias.Small Bowel Obstruction.g. The upright view (right) demonstrates multiple air-fluid levels in the dilated loops in a typical configuration of a small bowel obstruction. resembling the appearance of feces  While adhesions are not imaged per se. tumor) suggested  Signs of strangulation include thickening of the bowel wall. gallstone ileus. increased attenuation of the bowel wall. closed loop obstructions which are usually not diagnosable on conventional radiographs . For a larger photo of the same image. stranding of the adjacent small bowel mesentery or pneumatosis intestinalis  CT may demonstrate tumors. Supine view of the abdomen (left) shows several dilated loops of small bowel in the upper abdomen. The patient had previous bowel surgery. Crohn¶s disease.

U-shaped loop of small bowel  Does not change in position or size over time y Coffee bean sign or pseudotumor may be seen o Closed-loop obstructions are not usually diagnosable by conventional radiography and require CT  CT findings may include a U. the twisted loop itself remains dilated with gas and fluid thus producing a dilated. Axial CT scan through the lower abdomen shows multiple fluid-filled and dilated loops of small bowel (white arrows) and collapsed right colon (red arrow) consistent with a mechanical small bowel obstruction. y y Closed-loop obstructions o Most (75%) are caused by adhesions o In a closed-loop obstruction.CT of Small Bowel Obstruction.or C-shaped loop of small bowel  A spoke-like configuration of the mesentery demonstrating stretched vessels converging on the site of the twist may be seen y The appearance of the tightly twisted mesentery has been called the whirl sign  The beak sign may be seen as a fusiform tapering at the site of the obstruction Treatment of small bowel obstruction .

presents with painless hematuria in 6th or 7th decades.assocaited with Celiac Disease. can be AD or AR. doesn't destory all of kindney. think neoplasm. assoc w/ von Hippel Lindua syndrome (which is associ with other tumors) . intermittent hematuria -Alports syndrome .Many patients are treated conservatively with small bowel decompression and intravenous fluids o Surgical intervention may be necessary if there are signs and symptoms of strangulation. renin secretion. HTN due to Inc. --» usually unilateral.fusion of foot procesess are due to injury induced by T-cell derived cytokines -RCC --» see painless hematuria in an adult.Wegner's granulamoutousisisis(sp?) and microscopic polyangitis -IgA nephropathy (berger's Disease) .granular deposits are of IgG and C3 -minimal change disease .XD. peritonitis or lack of response to conservative treatment o Differentiating SBO from Paralytic Ileus SBO Etiology Pain Abdominal distension Bowel sounds Small bowel dilatation Large bowel dilatation Patient with prior surgery weeks to years prior Colicky Frequently prominent Usually increased Present Absent Ileus Recent (hours) post-operative patient Not a prominent feature Sometimes not apparent Usually absent Present Present Renal Path -Type II Rapidly Progressive (cresentic) GN associated with SLE and Henoch-Schlura purpura Type III . no sig loss of renal fxn. 1) Clear Cell Ca --» MC. 80% show sporadic loss of VHL gene --» germ line mutation of VHL loss occurs in 4th decade of life. -Nephrotic Syndrome --» see Oval Fat bodies which are sloughed tubular cells containing abundant lipid -membranous GN . foamy change in tubular epithelial cells.

see eosinophils in urine -ATN due to ischemia 1) accompanied by rupture of basement membrane (tubulorrhexis?) 2) 3 phases.chr usage of acetaminophen and aspirin -Simple cysts common in adults. assoc with berry aneurysm.2) Papillary variant of RCC --» MET on chr7 -Hemolytic-Uremic Syndrome (HUS) 1)MCC of acute renal failure in children. but not as numerous as those in APKD. infxn. non-smooth kidney surface -Juvenille Polycystic Kidney Disease (JKPD) AR.inc. (a) initiating phase. -Hypercalcicuira doesn't have to be linked to Hypercalcemia. can hemorrhage into cyst -Chronic Pyelonephritis due to reflux nephropathy 1)coarse and irregular scarring from asc. Inc.COli o157:h7 2) may see microangiopathic hemolytic anemia -Adult Polycystic Kidney Disease (APKD) MC C/x are HTN and infection. T/x = thiazide diuretics -Acute drug-induced intersititial nephritis 1) caused by ampicillin (PCN?). can see cysts in liver and pancreas as well. occurs in neonates or prenatal. cysts involve liver. Analgesic nephopathy . -Renal Papillary Necrosis 4. AD (= adult onset of the dz). replace kidney. 2)blunting and deformity of the calyces . may be multiple. urinary output and hypokalemia then restoration of of tubular fxn. kidneys have smooth surface. risk of RCC. no renal failure. lasts 1 day (b) maintenance phase progrossive oliguria and increasing BUN levels with salt and h20 overload (c) recovery phase . occurs after ingestion of meat infected with E. may become as large as 10cm. cysts are 1-4cm.

-Prerenal Azotemia = basically due to Dec. etc[/b] . C.O. ==» Dec. RBF.

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