Sllavko K.

Kallfa





Prmbledhje Artikujsh nga
Radiopaedia.org


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Processed animal product
containing foods X-Ray signs



honeycomb lung : f.3
mesenteric hamburger sign : f.12
omental cake : f.16
sausage digit : f.23
head cheese sign : . f.24
leather bottle stomach : of linitis plastica (or water
bottle sign)..f.31
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Honeycombing
Dr Andrew Dixon and Dr Behrang Amini et al.
Honeycombing refers to the computed tomographic (CT) manifestation of diffuse pulmonary
fibrosis (usual interstitial pneumonia). CT demonstrates clustered cystic air spaces (between 0.3-
1.0 cm in diameter), which are usually subpleural and basal in distribution. The walls of the cysts
are well-defined and often thick (1-3 mm
4
). Honeycombing is an irreversible finding
in interstitial lung disease and associated with a poor prognosis.
Differential diagnosis
air-space consolidation in the presence of pulmonary emphysema can mimic this appearance.
in some situations, paraseptal emphysema and paracicatrical emphysema can also mimic
honeycombing
3

Etymology
The term honeycomb lung is thought to have originated in the 19
th
century in Germany and is
thought to have first appeared in 1949 in a study by N Oswald and T Parkinson
5
.
References
1. Austin JH, Mller NL, Friedman PJ et-al. Glossary of terms for CT of the lungs:
recommendations of the Nomenclature Committee of the Fleischner Society. Radiology.
1996;200 (2): 327-31. Radiology (citation) - Pubmed citation
2. Mueller-mang C, Grosse C, Schmid K et-al. What every radiologist should know about
idiopathic interstitial pneumonias. Radiographics. 27 (3): 595-615. doi:10.1148/rg.273065130 -
Pubmed citation
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3. Arakawa H, Honma K. Honeycomb lung: history and current concepts. AJR Am J Roentgenol.
2011;196 (4): 773-82. doi:10.2214/AJR.10.4873 - Pubmed citation
4. Watadani T, Sakai F, Johkoh T et-al. Interobserver variability in the CT assessment of
honeycombing in the lungs. Radiology. 2013;266 (3): 936-44. doi:10.1148/radiol.12112516 -
Pubmed citation
5. Johkoh T, Sakai F, Noma S et-al. Honeycombing on CT; its definition, pathologic correlation,
and future direction of its diagnosis. Eur J Radiol. 2013; . doi:10.1016/j.ejrad.2013.05.012 -
Pubmed citation
Synonyms & Alternative Spellings
Synonyms or Alternative Spelling Include in Listings?
Honeycomb lung
Honeycombed lung
Honeycomb lungs
Honeycombed lungs
Honey combing

obtained from wikipedia.org
honeycombing and pulmonary fibrosis
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pulmonary fibrosis with
prominent honeycombing. Image courtesy of Dr Frank Gaillard .
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From the case: Honeycomb lung - gross pathology
Modality: Photo
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From the case: Honeycombing in an usual interstitial pneumonia (UIP) pattern
Modality: CT
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From the case: Honeycombing in an usual interstitial pneumonia (UIP) pattern
Modality: CT

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Axial non-contrast
Predominantly basal and peripheral reticular opacities with honeycombing and traction bronchiectasis.
From the case: Usual interstitial pneumonia
Modality: CT
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From the case: Rheumatoid interstitial lung disease
Modality: CT
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Sandwich sign
Dr Frank Gaillard et al.
A sandwich sign (sometimes known as a hamburger sign) refers to a mesenteric +/- para-aortic
nodal mass giving an appearance of a hamburger. Confluent lymphadenopathy on both sides of
the mesenteric vessels gives rise to an appearance described as the sandwich sign.
2

The sign is specific for mesenteric lymphoma (typically non-Hodgkins) unless the patient has
had a transplant. If so, posttransplant lymphoproliferative disorder should be considered.
1

References
1. Hardy SM. The sandwich sign. Radiology. 2003;226 (3): 651-2. doi:10.1148/radiol.2263020109
- Pubmed citation
2. Haaga JR, Boll D. CT and MRI of the whole body. Mosby. (2009) ISBN:0323053750. Read it at
Google Books - Find it at Amazon
Synonyms & Alternative Spellings
Synonyms or Alternative Spelling Include in Listings?
hamburger sign

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From the case: Hamburger sign
Modality: CT

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From the case: Sandwich sign
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From the case: Hamburger sign in patient with CLL
Modality: CT
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Omental cake
Dr Frank Gaillard et al.
An omental cake refers to infiltration of the omental fat by material of soft-tissue density.
The most common cause is metastases from ovarian, gastric or colon cancer. Tuberculous
peritonitis may also give this appearance. Masses on the peritoneal surfaces may also be present.
Malignant ascites may be present. Lymphoma can present as omental caking, diffuse peritoneal
thickening, and ascites, the best clue is significant lymphadenopathy.
A core biopsy may be helpful if the primary tumour is unknown.
References
1. Weissleder R, Wittenberg J, Harisinghani MG. Primer of diagnostic imaging. Mosby Inc. (2003)
ISBN:0323023282. Read it at Google Books - Find it at Amazon
2. Roche CJ, O'keeffe DP, Lee WK et-al. Selections from the buffet of food signs in radiology.
Radiographics. 22 (6): 1369-84. doi:10.1148/rg.226025521 - Pubmed citation
Toma P, Granata C, Rossi A et-al. Multimodality imaging of Hodgkin disease and non-Hodgkin
lymphomas in children. Radiographics. 2007;27 (5): 1335-54. Radiographics (full text) -
doi:10.1148/rg.275065157 - Pubmed citation
Synonyms & Alternative Spellings
Synonyms or Alternative Spelling Include in Listings?
Omental caking

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C+ portal venous phase
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From the case: Omental
cake
Modality: CT
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From the case: Omental cake
Modality: CT
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Sausage digit
Dr Jeremy Jones and Dr MT Niknejad et al.
The term sausage digit refers to the clinical and radiologic appearance of diffuse fusiform
swelling of a digit due to soft-tissue inflammation from underlying arthritis or dactylitis.
The common causes of sausage digit are :
psoriatic arthropathy
osteomyelitis
sickle cell anemia
sarcoidosis
tuberculous dactylitis (spina ventosa)
leukemia
syphilitic dactylitis
gout
References
1. Roche CJ, O'Keeffe DP, Lee WK et-al. Selections from the buffet of food signs in radiology.
Radiographics. 2002;22 (6): 1369-84. Radiographics (full text) - doi:10.1148/rg.226025521 -
Pubmed citation
2. Davies SG. Aids to Radiological Differential Diagnosis. Saunders Ltd. (2009) ISBN:0702029793.
Read it at Google Books - Find it at Amazon
3. Longo D, Fauci AS, Kasper D et-al. Harrison's Principles of Internal Medicine. McGraw-Hill
Professional Pub. (2011) ISBN:007174889X. Read it at Google Books - Find it at Amazon
Synonyms & Alternative Spellings
Synonyms or Alternative Spelling Include in Listings?
Sausage digit sign
Sausage digit appearance Sausage sign

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Head cheese sign
Dr Frank Gaillard et al.
Head cheese, believe it or not, is not a cheese and is often not made of head. It is in fact a type of
terrine, with bits of meat scavenged from various parts of various animals (including the head)
usually from a calf or pig. It has a heterogeneous mosaic pattern, ranging from light to dark.
The appearance of the cut surface of this dubious delicacy has been likened to that
hypersensitivity pneumonitis, where there is a combination of :
lung consolidation
ground glass opacities
normal lung
hyperinflated / air trapped lung (mosaic attenuation)
References
1. High-resolution CT of the lung. W. Richard Webb, Nestor L. Muller, David P. Naidich.
Philadelphia : Lippincott Williams & Wilkins, c2001. ISBN:0781722780 (find it at amazon.com)
2. Webb WR. Thin-section CT of the secondary pulmonary lobule: anatomy and the image-the
2004 Fleischner lecture. Radiology. 2006;239 (2): 322-38. doi:10.1148/radiol.2392041968 -
Pubmed citation
Synonyms & Alternative Spellings
Synonyms or Alternative Spelling Include in Listings?
Head cheese sign - chest

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Head cheese Image courtesy of Tamorlan. Please see case description page for licence and original file
information. From the case: Head cheese - photo
Modality: Photo
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From the case: Hypersensitivity pneumonitis - probable sub acute to chronic
Modality: CT
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From the case: Hypersensitivity pneumonitis - probable sub acute to chronic
Modality: CT
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Linitis plastica
Dr Garth Kruger and Dr Frank Gaillard et al.
Linitis plastica is a descriptive term usually referring to the appearance of the stomach, although
the rectum can also be described thus
3
(see linitis plastica of the rectum). The appearance is said
to be reminiscent of a water-bottle... the old leather kind rather than the colourful rubber ones of
today I am guessing.
Etymology:
Linitus: inflammatory change, plastica : inelastic, not pliable
Pathology
The underlying cause is usually a scirrhous adenocarcinoma with diffuse submucosal infiltration,
leading to thickening and rigidity to the stomach wall
2
.
It is important to realise that as the infiltration is submucosal, gastric biopsies are frequently
negative
2
.
Radiographic features
Fluoroscopy - Barium meal
Due to the increased rigidity of the wall, the stomach cannot be adequately distended, with only a
narrow lumen identified. The normal mucosal fold pattern is absent, either distorted, thickened or
nodular
2
.
CT
Typically the stomach is diffusely thickened with a small lumen. Evidence of nodal involvement
or wide spread metastatic disease should also be sought.
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Differential diagnosis
Whether you define linitis plastica as only the appearance of the stomach, irrespective of cause
or use it only in the setting of infiltrating adenocarcinoma of the stomach is up to you, but be
aware that there does not appear to be general agreement. Thus the cause of linitis plastica are
also the differential, and include
4,5
:
neoplastic
o gastric adenocarcinoma (scirrhous)
o metastases
breast
lung
lymphoma : less rigid
diffuse gastric diverticula (rare)
6

inflammatory
o radiotherapy
o eosinophilic enteritis
o granulomatous disease
Crohn's disease
tuberculosis
sarcoidosis
scarring (e.g. ingestion of corrosives)
gastric amyloidosis
Etymology
The term was coined by William Brinton (1823 - 1867) in 1854. Hence also unsurprisingly
called Brinton's disease.
References
1. Levine MS, Pantongrag-brown L, Aguilera NS et-al. Non-Hodgkin lymphoma of the stomach: a
cause of linitis plastica. Radiology. 1996;201 (2): 375-8. Radiology (abstract) - Pubmed citation
2. Curati WL. Imaging in Oncology. Cambridge Univ Pr. (1998) ISBN:1900151030. Read it at
Google Books - Find it at Amazon
3. Rudralingam V, Dobson MJ, Pitt M et-al. MR imaging of linitis plastica of the rectum. AJR Am J
Roentgenol. 2003;181 (2): 428-30. AJR Am J Roentgenol (full text) - Pubmed citation
4. 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
5. Chapman S, Nakielny R. Aids to radiological differential diagnosis. Saunders Ltd. (2003)
ISBN:0702026506. Read it at Google Books - Find it at Amazon
6. Patel SD, Semeraro D, Hall RI. Linitis plastica due to gastric diverticulosis. J R Soc Med. 2005;98
(9): 416-7. doi:10.1258/jrsm.98.9.416 - Free text at pubmed - Pubmed citation

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DWI
Water bottle Boer water bottle from the Boer war in South Africa. See image page for further details
including license. Boer water bottle from the Boer war in South Africa.Photograph was taken in the
Somerset County Museum in Taunton on 29-Oct-05.Author: Gaius CorneliusOriginal file:
http://commons.wikimedia.org/wiki/File:Boer_water_bottle_circa_1900.JPGLicense: I, the copyright
holder of this work, hereby release it into the public domain. This applies worldwide.In case this is not
legally possible:I grant anyone the right to use this work for any purpose, without any conditions, unless
such conditions are required by law.If you believe your copyright or has been infringed please write to
license@radiopaedia.org giving details of why you believe this is so.
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From the case: Linitis
plastica
Modality: CT
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Macro - Stomach, opened longitudinally along the lesser curve. There is marked thickening of the gastric
wall with mucsoal congestion and decrease in rugal folds. There was no localised mucosal lesion and no
evidence of erosion or ulceration.
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From the case: Linitis plastica
Modality: CT
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From the case: Gastric
carcinoma "linitis plastica" and peritoneal carcinomatosis
Modality: CT