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Sllavko K. Kallfa





Prmbledhje Artikujsh nga
Radiopaedia.org
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fish and seafood
X-Ray signs



o endosteal scalloping...............f.3
o fish vertebra.....................................f.8
o fishtail deformity.......................f.10
o lobster claw sign.........................f.11
o manta ray sign..............................f.12
o vertebral scalloping...............f.16







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Endosteal scalloping
Dr Henry Knipe and Dr Frank Gaillard et al.
Endosteal scalloping refers to the focal resorption of the inner margin of cortical bones,
typically seen in long bones, due to slow growing medullary lesions.
It is important to note that although it is evidence of a slow non-infiltrative lesion, it does not
equate to benign aetiology. In fact although the appearance of the cortico-medullary junction of
bones affected with myeloma and metastases can look very similar (and the term endosteal
scalloping is used by many authors) the underlying mechanism of resorption may well be
different
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.
Differential diagnosis
Lesions that typically result in endosteal scalloping include:
benign
o enchondroma
o chondromyxoid fibroma
o chondroblastoma
o brown tumour
o skeletal amyloidosis
o osteomyelitis
o fibrous dysplasia
o anaemias
o periprosthetic osteolysis
malignant
o chondrosarcoma (usually low grade)
o skeletal metastases
o multiple myeloma
References
1. Burgener FA, Kormano M, Pudas T. Differential diagnosis in conventional radiology.
Thieme Publishing Group. (2008) ISBN:3136561031. Read it at Google Books - Find it
at Amazon
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2. Reeder MM, Felson B. Reeder and Felson's gamuts in radiology, comprehensive lists
of roentgen differential diagnosis. Springer Verlag. (2003) ISBN:0387955887. Read it at
Google Books - Find it at Amazon
3. Matsumoto T, Abe M. Bone destruction in multiple myeloma. Ann. N. Y. Acad. Sci.
2006;1068 : 319-26. doi:10.1196/annals.1346.035 - Pubmed citation
From the case: Multiple myeloma - femur
Modality: Annotated image
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From the case: Multiple myeloma - femur
Modality: Annotated image
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From the case: Right humeral lytic lesion - non
small cell lung cancer metastasis
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Modality: X-ray
From the case: Endosteal scalloping in myeloma
Modality: X-ray



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Fish vertebra
Dr Yuranga Weerakkody and Dr Jeremy Jones et al.
A fish vertebra (or codfish vertebra) describes the biconcave appearance of lumbar vertebrae
in patients with
osteoporosis
sickle cell disease.
hereditary spherocytosis
homocystinuria
renal osteodystrophy
thalassemia major(rarely)
References
1. Ntagiopoulos PG, Moutzouris DA, Manetas S. The "fish-vertebra" sign. Emerg Med J.
2007;24 (9): 674-5. doi:10.1136/emj.2006.039131 - Free text at pubmed - Pubmed
citation
2. Burgener FA, Kormano M, Pudas T. Differential Diagnosis in Conventional
Radiology. Thieme. (2008) ISBN:1588902757. Read it at Google Books - Find it at
Amazon
Synonyms & Alternative Spellings
Synonyms or Alternative Spelling Include in Listings?
Codfish vertebra
Fish vertebrae

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From the case: Codfish vertebra - osteoporosis
Modality: CT



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Fishtail deformity of the elbow
Dr Jeremy Jones and Dr MT Niknejad et al.
Fishtail deformity of the elbow is characterised by a contour abnormality of the distal humerus,
which develops when the lateral trochlear ossification centres fails to develop or resorbs.
It is an uncommon complication usually following a distal humeral fracture in childhood. Whilst
initially presumed to be a benign condition, long-term follow-up suggests that patients with
fishtail deformity are prone to:
functional impairment
ongoing pain and
the development of early osteoarthrosis.
References
1. Hayter CL, Giuffre BM, Hughes JS. Pictorial review: 'fishtail deformity' of the elbow.
J Med Imaging Radiat Oncol. 2010;54 (5): 450-6. doi:10.1111/j.1754-9485.2010.02206.x
- Pubmed citation
2. Weissleder R, Wittenberg J, Harisinghani MG et-al. Primer of diagnostic imaging.
Mosby Inc. (2007) ISBN:0323040683. Read it at Google Books - Find it at Amazon







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Lobster claw sign
Dr Jeremy Jones and Dr MT Niknejad et al.
The descriptive terms lobster claw sign (or ball-on-tee sign/ or renal signet ring sign) refer to
the radiographic patterns of papillary excavation seen with renal papillary necrosis.
The necrotic papillary tip may remain within the excavated calix, producing the signet ring
sign when the calix is filled with contrast material. The devitalized papilla may act as a nidus for
calcification, thus creating a true stone for the signet ring.
The patterns of papillary excavation are best seen with standard excretory urography or
retrograde urography.
References
1. Dyer RB, Chen MY, Zagoria RJ. Classic signs in uroradiology. Radiographics.
2004;24 Suppl 1 (suppl 1): S247-80. doi:10.1148/rg.24si045509 - Pubmed citation
Synonyms & Alternative Spellings
Synonyms or Alternative Spelling Include in Listings?
Ball-on-tee sign
Signet ring sign - renal







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Manta ray sign
Dr Henry Knipe and Dr Andrew Dixon et al.
The manta ray sign is a radiographic appearance in bladder exstrophy. It describes wide midline
separation of the pubic bones simulating the appearance of a manta ray swimming towards you
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.
The smooth arc of the pelvis outline in bladder exstrophy is in contrast to acquired separation of
the pubic symphysis seen in open book pelvic injuries.

References
1. Bull, M. [mattdbull]. (2014, July 21). Always reminds me of a manta ray when I see
this #isthatpublished? [Tweet]. Retrieved from
https://twitter.com/mattdbull/status/49118544320845240
Synonyms & Alternative Spellings
Synonyms or Alternative Spelling Include in Listings?
Manta ray appearance

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From the case: Bladder exstrophy
Modality: Photo
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From the case: Bladder exstrophy
Modality: X-ray
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Imaging Differential Diagnosis
From the case: Pelvic open book fracture
Modality: X-ray

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Vertebral scalloping
Dr Frank Gaillard et al.
Vertebral scalloping is a concavity to the posterior (or less commonly anterior) aspect of the
vertebral body when viewed in a lateral projection. A small amount of concavity is normal, as is
concavity of the anterior vertebral body (see vertebral body squaring).
Posterior scalloping
Causes of posterior scalloping include:
achondroplasia
an intraspinal masses, such as
o spinal astrocytoma
o ependymoma
o spinal schwannoma
o myxopapillary ependymoma
o spinal paraganglioma
o neurofibroma as seen in neurofibromatosis type 1
dural ectasia as seen in
o neurofibromatosis type 1
o a hereditary connective tissue disorder such as
Marfan disease
Ehlers-Danlos disease
osteogenesis imperfecta tarda
mucopolysaccharidoses
acromegaly
Anterior scalloping
Causes of increased anterior scalloping include:
retroperitoneal lymphadenopathy
o chronic leukaemia and lymphoma
o tuberculosis
o many others
abdominal aortic aneurysm
Down syndrome
References
1. Eisenberg RL. Clinical Imaging, An Atlas of Differential Diagnosis. Lippincott
Williams & Wilkins. (2009) ISBN:0781788609. Read it at Google Books - Find it at
Amazon
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2. Wakely SL. The posterior vertebral scalloping sign. Radiology. 2006;239 (2): 607-9.
doi:10.1148/radiol.2392040224 - Pubmed citation
Synonyms & Alternative Spellings
Synonyms or Alternative Spelling Include in Listings?
Scalloping of the vertebrae
Scalloping of vertebrae
Vertebral body scalloping
Scalloping of vertebral bodies

From the case: Spinal schwanoma
Modality: MRI
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From the case: Achondroplasia
Modality: X-ray
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From the case:
Achondroplasia
Modality: X-ray
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From the case: Long-standing schwannoma with vertebral scalloping
Modality: CT
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From the case: Lumbar
ependymoma
Modality: X-ray
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From the case: Lumbar
ependymoma
Modality: X-ray
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From the case: Spinal
paraganglioma
Modality: MRI