Some important signs in MCQs and Oral questions

Apple core lesion :- Signifies annular carcinomas of the colon ----looks like an apple core or napkin ring due to circumferential narrowing
of the lumen, noted on contrast studies.

Bamboo spine :- Fused spinal segments with their syndesmophytes look, on radiographs, similar to bamboo stalks----classically associated
with Ankylosing spondylitis.

Bird's Beak :- 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 :- Due to RVH, the LV is lifted above the edge of the diaphragm, forming the ''toe'' of the boot. Classic for Tetrallogy
of fallot.

Bat's Wing/Butterfly :- This appearance on CXR is classically associated with CHF and resultant pulmonary edema.

Cobblestone appearance :- This sign is produced on barium studies due to ulcerative pockets, usually in the terminal ileum, indicative of
Crohn's.

Codman's Triangle :- A triangle on plain film of extremities that signifies reactive bone, classically associated with Osteosarcoma,
or other infectious/hemorrhagic process that causes Periosteal elevation.

Coin lesion :- Solitary pulmonary nodule; (may be cancer or granuloma).

Cookie cutter lesions :- Metastatic lesions to bone cortex, or Paget's.

Crescent sign :- Classic sign of avascular necrosis, femoral head.

Double-bubble sign :- - Duodenal atresia. - Duodenal stenosis. - Annular pancreas.

Triple-bubble sign :- - Jejunal atresia.

Coffee bean sign :- - Strangulation of incompletely obstructed loop of small intestine.

String of beads :- - Small bowel obstruction.

Coiled spring appearance :- - Intussusception.

Pincer-shaped ending in barium enema :- - Intussusception.

Bird of prey sign :- - Sigmoid volvulus.

Moulage sign (flocculation of barium, with mucosal thickening) :- - Malabsorption syndrome.

String sign of Cantor :- - Crohn's disease.

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Pipe-stem appearance (Loss of Haustrations) :- - Ulcerative colitis (Barium Enema)

Saw-tooth appearance and/or diverticula :- - Diverticular disease/ Diverticulosis (Barium Enema)

Scalloping of edge of sigmoid colon on barium enema :- - Ulcerative colitis.

Napkin ring sign :- - Annular carcinoma of colon.

Porcelain gallbladder :- - Carcinoma of gallbladder.

Pad sign :- - Carcinoma pancreas (Barium meal) ERCP.

Scrambled Egg appearance :- - Carcinoma of pancreas.

Chain of Lakes appearance :- - Chronic pancreatitis.

Double duct sign :- - Carcinoma of pancreas.

Meniscus sign :- - Choledocholithiasis.

Bird's Beak deformity of lower oesophagus :- - Achalasia cardia (Barium swallow).

Honeycomb lung :- Used to describe any pathologic process that causes radiographic appearance of multiple small, thick-walled cystic
spaces; (e.g. Pulmonary fibrosis)

Lead pipe sign :- Classic narrowing of bowel lumen, with loss of haustra---UC.

Napkin ring sign :- See Apple core lesion above; pathology identical, but lumen more narrowed.

Onion-skinning :- Layered look of periosteum in Ewing sarcoma.

Rachitic Rosary :- This is a ''String of beads'' appearance on X-ray, a thickening of costochondral margins that is noted in Ricketts
(Vit. D deficiency).

Sail sign :- Fat pad noted on plain film, indicative of shoulder dislocation.

Scotty dog (collar) :- On posterior oblique, the lumber vertebrae look like a scottish terrier. The neck is the pars interaticularis, and a
break (a collar) noted there indicates spondylolysis.

String sign :- Thin, slightly irregular shadow in narrowed lumen of ileum, suggestive of Crohn's.

Silhouette sign :- Obliteration of cardiovascular silhouette due to adjacent disease, (i.e pneumonia, TB, ect.).

Stepladder appearance :- Distended bowel loops, often indicative of obstruction, usually SBO.

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Sunburst appearance :- ''Clouds, clumps, and consolidation rays'' of tissue emanating from bone cortex, or within bony structures,
indicative of osteosarcoma.

Thumb (print) sign :- On lateral C-spine, an enlarged epiglottis appears as a ''thumb''---epiglottitis.

Wester-mark's sign :- Abrupt end to a pulmonary vessel, signifying oligemia or PE.

Rat tail tapering of lower oesophagus :- Carcinoma oesophagus (Barium swallow).

Cork screw oesophagus :- Diffuse oesophageal spasm (Barium swallow).

Commonest radiological appearance of gastric carcinoma (in barium meal follow through) is filling defect in antrum/body of
stomach.

Trifoliate duodenum :- Chronic duodenal ulcer with scarring (Barium meal).

Hour Glass stomach :- - Peptic ulcer.

Cup and spill/ Cascade stomach :- Volvulus of stomach.

Constriction of transverse duodenum :- Superior mesenteric artery syndrome.

Bull's eye lesion (in barium meal) :- Leiomyosarcoma.

Single-bubble appearance :- Pyloric stenosis.

Egg-on-String :- Large, ovoid-shaped heart on newborn CXR, classically signifying complete transposition of the great vessels with intact
ventricular septum.

Ground glass :- A ''white out'' on CXR, usually PCP pneumonia or ARDS.

Hampton's Hump :- A peripheral triangle, usually near pleural edges, classically PE.