Radiologic Signs

A Index Accordion Sign-appearance of oral contrast trapped between colonic folds thickened by submucosal edema, esp in C. difficile colitis Abdominal Cocoon-AKA sclerosing encapsulating peritonitis; encasement of variable lengths of bowel by a dense fibrocollagenous membrane giving the appearance of a cocoon Air Crescent Sign-sickle-shaped lucency partly surrounding a mass in a pulmonary cavity on chest xray & CT; classically, aspergillomas Air Bronchogram Sign-black-branching air-filled bronchi visible because of surrounding airspace disease, such as in pneumonia Angel Wing Appearance-AKA Bat Wing-pattern of pulmonary edema which involves perihilar regions and spares cortex of lung Anteater's Nose Sign-on lateral view of foot, elongated anterior, superior process of calcaneous seen in tarsal coalition Aortic Nipple-bump caused by left superior intercostal vein as it wraps around outer edge of aorta

Apple Core-appearance of an annular constricting carcinoma of the bowel, usually the colon, from circumferential involvement of lumen Acorn cyst-breast-breast-US-type of complex cyst where the echogenicity within the cyst is due to fat and protein cells; also known as Fatty Cyst Absent Bow-Tie Sign-absence of normal bow-tie appearance of meniscus on sagittal MRI of knee in bucket handle tears B Index Bat Wing Appearance-AKA Angel Wing-pattern of pulmonary edema which involves perihilar regions and spares cortex of lung Berry Aneurysm-an intracranial aneurysm most often occurring in the Circle of Willis, particularly at the junction of major vessels in the anterior circulation Blade of Grass Sign-AKA flame sign; advancing, wedge-shaped, osteolytic margin of active Paget disease of bone; usually seen in diaphysis Beveled Edge Appearance-asymmetric erosion of the inner and outer tables of the skull usually seen with eosinophilic granuloma Bird's Beak Sign-AKA Rat-tail Sign; irregularly marginated tapering of esophagus in achalasia

Bowler Hat Sign-cup-shaped filling defect seen on air contrast BE that represents polyp if it points toward lumen and tic if it points away Black Pleural Line-paradoxical appearance of pleura in pulmonary microlithiasis because of innumerable dense calcifications in adjacent lung Bird of Prey Sign-tapered barium column in sigmoid volvulus; Bird's beak sign in achalasia Boot-shaped Heart-shape of heart in Tetralogy of Fallot due to upturned apex from RVH and concave pulmonary artery segment Bowtie Appearance-of facets in the cervical spine on lateral view in unilateral rotatory subluxation at and above the site of rotation Bamboo Spine-undulating contour of spine caused by bridging syndesmophytes seen in ankylosing spondylitis Bucket Handle Tear-vertical tear in knee of mostly medial meniscus with displacement of fragment toward notch Butterfly Vertebra-congenital sagittal cleft through center of vertebra with funnel-shaped ends on AP view of spine

Bone-within-a-Bone-inner layer of cortical new bone within an existing bone seen with osteopetrosis, Sickle Cell Dz, Thorotrast Breast-within-a-Breast-in fibroadenolipoma /hamartoma of breast; benign proliferation of normal breast components fibrous, glandular, and fatty tissues are surrounded by a thin capsule of connective tissue Bear Paw Sign-dilated renal calyces with normal renal pelvis seen in calculus disease and xanthogranulomatous pyelonephritis Boutonniere Deformity-hyperextension of distal interphalangeal joint and flexion of proximal interphalangeal joint in RA Brim Sign-thickening of the iliopectineal line (pelvic brim) in Paget's disease Boomerang Sign-hyperintense signal in the splenium of the corpus callosum accompanying stroke; also an MRI sign in peroneus brevis split syndrome Box-shaped Heart-squared-off appearance of the heart in Ebstein's Anomaly due to large right atrium and dilated right ventricular outflow tract Bite Sign-MSK-gouged-out defect due to collapse of bone in head of femur in avascular necrosis

Bulging Fissure Sign-bulging of usually minor fissure from heavy,exudative pneumonia like Klebsiella Banana Sign-abnormal shape of the cerebellum from compression seen on antenatal US in spina bifida and other neural tube defects C Index Carman Mensicus Sign-large gastric ulcer seen on UGI convex in towards the lumen of the stomach, the rolled edges indicative of malignancy Cortical Ring Sign-circular shadow cast by rotated scaphoid in scapholunate subluxation secondary to scaphoid's abnormal orientation Coin Lesion-a solitary pulmonary nodule generally considered less than 3 cm in size, most often a granuloma or hamartoma Codman's Triangle-triangular elevation of periosteum from an aggressive, usually malignant, bone tumor such as an osteosarcoma Cotton Wool Appearance-islands of poorly marginated sclerotic disease surrounded by less dense skull in Paget disease

Cobra Head Abnormality-rounded dilatation of distal ureter, surrounded by thin lucent line, seen in patients with adult-type ureteroceles Cobblestone Appearance-GI-alternating normal and denuded mucosa from ulceration, esp in Crohn's disease of the colon C Sign-on lateral view of foot in tarsal coalition, a continuous arc from medial cortex of talus to inferior cortex of sustentaculum talus Cervicothoracic Sign-a mass extends above clavicles on frontal chest radiograph should be posterior in chest Cluster of Grapes Sign-multiple gas-containing cysts usually in segment of left colonic wall in pneumatosis cystoides intestinalis Coffe-bean Sign-dilated sigmoid colon in sigmoid volvulus thought to resemble a giant coffee-bean Colon Cutoff Sign-dilated transverse colon, usually to splenic flexure, associated with pancreatitis or ischemic colitis Comb Sign-contrast-enhanced tubular opacities on the mesenteric side of the ileum aligned like the teeth of a comb, especially in Crohn disease

Comet Tail Sign-lung-focal area of collapsed lung adjacent to pleural thickening with distortion of blood vessels in rounded atelectasis Comet Sign-appearance of a calcified phlebolith and its adjacent non-calcified vein; may aid in DDX from ureteral calculus Continuous Diaphragm Sign-visualization of entire upper surface of diaphragm from pneumomediastinum Corduroy Sign-vertically oriented, thickened trabeculae seen in vertebral body hemangiomas Corkscrew Esophagus-constricted, twisted lumen usually seen in diffuse esophageal spasm from abnormal, tertiary contractions Crazy Paving Sign-fine reticular pattern superimposed on areas of ground-glass opacity on HRCT, first described with alveolar proteinosis Crescent Sign-appearance of a sliver of air usually best seen beneath the right hemidiaphragm in pneumoperitoneum Cannonball Metastases-large, hematogebously spread metstatic lesions in the lungs of varying sizes most often from colon, breast, renal, thyroid primaries

Cockade Sign-intraosseous calcaneal lipoma with central calcification resembling the badge generally worn upon a hat Collar Button Ulcer-GI-ulceration with undermining of submucosa producing distinctive shape, esp with ulcerative colitis Champagne Glass Pelvis-squaring of the iliac wings in achondroplasia producing a champagne glass appearance of the pelvic inlet Crescent Sign (Hip)--subarticular radiolucency of femoral head seen best on frog lateral in avascular necrosis Celery Stalking-striated appearance of metaphyses in patients with rubella and osteopathia striata; also degenerated ACL on MRI Corkscrew Sign-spiral appearance of 4th part of duodenum on UGI in children with mid-gut volvulus Cottage Loaf Sign-constricted appearance of liver herniated through a right-sided diaphragmatic rupture looks like English cottage loaf Coned Epiphyses-are usually normal but may occur in sickle cell anemia, congenital diseases, infection, trauma, and radiation injury

Codfish Vertebra-biconcave appearance of the vertebral bodies themselves in sickle cell disease from avascular necrosis resembling the vertebra of codfish Crowded Carpal Sign-overlap of the distal and proximal carpal rows in perilunate dislocation Cobblestone Pattern-hysterosalpingography-rounded filling defects from intraluminal adhesions

D Index David Letterman Sign-widening of distance between the scaphoid and lunate (>3mm) on PA view from ligament disruption-AKA Terry Thomas sign Dense MCA Sign-early CT sign, <6hrs, of ischemic stroke seen with thrombosis of the middle cerebral artery; false + findings may occur Double Bubble Sign-dilated stomach and proximal duodenum in newborn, typically seen in duodenal atresia, midgut volvulus or annular pancreas Double Density Sign-overlapping of an enlarged left atrium and the normal right atrium on a frontal chest radiograph

Doughnut Sign-in nucs, radiotracer uptake surrounding a photopenic testis in testicular torsion; in GI CT, thickening of the bowel wall Dense Hilum Sign-appearance of hilum which is neither enlarged nor calcified implying superimposed lung density Draping Aorta Sign-blood that has leaked from the abdominal aorta Deep Sulcus Sign-inferiorly depressed costophrenic angle from pneumothorax seen on supine radiograph of chest Double Bronchial Wall Sign-air outlining the trachea and proximal bronchi in pneumomediastinum Drooping Lily Sign-appearance of lower pole calyces in a duplicated collecting system with a non-functioning upper pole Double PCL Sign-low signal band parallel to PCL produced by fragment of meniscus in bucket handle tear on knee MRI Double Duct Sign-dilatation of both the common bile duct and pancreatic duct on cross-sectional imaging, mostly by ca of pancreatic head or ampulla of vater

Double Track Sign-UGI-redundant mucosa separates barium into two columns in pyloric channel in hypertrophic pyloric stenosis Dripping Candle Wax Sign-cortical hyperostosis on one side of bone likened to melting wax, seen in melorheostosis Dromedary Hump Sign-cortical bump on lateral aspect of left kidney caused by compression by adjacent spleen Drooping Shoulder Sign-inferior subluxation of shoulder from hemathrosis or flaccid paralysis Dagger Sign-dense line caused by ossification of supraspinous and interspinous ligaments in ankylosing spondylitis

Eggshell Calcification-lung-peripheral calcification of thoracic lymph nodes, most often seen in silicosis but also sarcoid or post-XRT Eggshell Calcification-breast-thin calcification of a spherical surface, usually benign, most commonly seen in fat necrosis and cysts Egg-on-a-String Sign-narrowing of superior mediastinum and globular shape of heart in neonates with Transposition of the Great Arteries

Erlenmeyer Flask Deformity-widening of metadiaphysis esp. in distal femur seen in Gaucher's, thalassemia and Pyle's disease Empty Sella-enlarged sella caused by arachnoid herniation through the diaphragma sellae compressing pituitary gland Eye-of-the-Tiger Sign-ring of low intensity in globus pallidus on T2 MRI most commonly in HallervordenSpatz syndrome Elephant-on-a-Flagpole Sign-appearance of a rounded extrarenal pelvis "sitting" atop the ureter

F Index Fallen Fragment Sign-small piece of bone settles to dependent portion of a unicameral bone cyst from pathologic fracture Fat Pad Sign-pericardium-pericardium-produced by separation of retrosternal fat from epicardial fat by a line >2 mm, seen on lateral chest radiograph Figure 3 Sign-in coarctation of the aorta, the dilated LSCA, indentation of coarct and post-stenotic aortic dilatation form "3"

Football Sign-oval shaped lucency of large pneumoperitoneum seen on supine abdominal radiographs usually in infants Fallen Lung Sign (AKA Ptotic Lung Sign)-drooping of the lung on chest x-ray or CT to dependent part of chest described with fracture of the bronchus Fishooking of Ureter-J-shaped appearance of distal ureter from enlargement of prostate and elevation of trigone usually in BPH Flame-shaped Breast-breast tissue in the subareolar region extending from the nipple in flame-shaped distribution, representative of gynecomastia Floating Teeth-alveolar bone destruction of part of the mandible from eosinophilic granuloma may make adjacent teeth appear to "float."Also may occur with other destructive lesions of mandible Falciform Ligament Sign-visualization of usually invisible falciform ligament from surrounding air in pneumoperitoneum Flat Waist Sign-flattened appearance to left side of cardiac contour due to rotation of heart in LLL atelectasis Fragment in Notch Sign-on coronal MRI, displaced fragment, usually of medial meniscus, in bucket handle tears

Feline Esophagus-transient transverse esophageal folds on double contrast esophagram possibly due to GE reflux Faceless Kidney Sign-obliteration of the normal renal sinus 1st described in duplications but now including neoplasm or inflammation Fat Pad Sign-elevation of extrasynovial, intracapsular fat around the elbow as a result of distension of the joint by an effusion, usually traumatic Fishmouthing-biconcave appearance of the disk spaces in sickle cell disease from avascular necrosis of the vertebral endplates resembling a fish mouth G Index Golden's S Sign-S shape caused by edge of elevated minor fissure and hilar mass in RUL atelectasis Ghost Vertebrae-bone-in-a-bone seen in spine with Thorotrast injection in childhood Gloved Finger Sign-finger-like projections from hilum from bronchial mucoid impaction in allergic bronchopulmonary aspergillosis or asthma

Goblet Sign-dilated, cup-shape of the ureter distal to an intraluminal filling defect such as tumor, seen best on retrograde studies Gull Wing Sign-DIP joints showing central erosions and marginal osteophytes in erosive osteoarthritis Golfball-on-a-Tee Sign-large cavity seen on CT urogram or IVP formed by sloughed necrotic papillae in renal papillary necrosis Gooseneck Sign-in left ventricular angiography, the shape of the LV and aorta in an endocardial cushion defect H Index Hampton's Line-thin line seen in profile at neck of gastric ulcer representing the thin rim of undermined gastric mucosa in a benign ulcer Hampton's Hump-wedge-shaped density at periphery of lung described as a sign of pulmonary infarction Honda Sign-characteristic H-shape, similar to carmaker's logo, of bone radiotracer uptake in sacrum due to sacral insufficiency fractures

Haglund's Sign-prominence of posterior, superior calcaneal tuberosity mostly in females from pressure by shoes Hide-Bound Appearance-narrow separation between normal thickness valvulae despite luminal dilatation; seen in scleroderma Hair-on-End-spiculated appearance of elongated trabeculae in widened diploic space seen in hemolytic anemias, esp thalassemia Hill-Sachs Deformity-fracture of the posterior and lateral portion of humeral head from an anterior shoulder dislocation H-shaped Vertebrae-central depressions in vertebral endplates caused by avascular necrosis, especially in sickle cell disease Honeycombing-clustered, thick-walled cystic spaces representing dilated and thickened bronchial walls; seen in bronchiectasis, CF, EG Hot Nose Sign-early, increased activity on nuclide blood flow brain scans in region of nose, esp in brain death Holly Leaf Appearance-the geographic shape formed by the dense perimeter of a calcified pleural plaque seen en face, especially with asbestos exposure

Hilum Overlay Sign-differentiates large pulmonary artery from hilar mass on chest x-ray; mass superimposes on vessels Hilum Convergence Sign-differentiates large pulmonary artery from hilar mass on chest x-ray; vessels converge on PA but go past hilar mass Hatchet Head Deformity-the appearance of the humeral head as result of severe erosions from rheumatoid arthritis Hamburger Sign-normal appearance of facet joints on CT of cervical spine resembling two halves of hamburger bun Heel Pad Sign-enlarged soft tissue of heel pad (greater than 23mm) that might indicate presence of acromegaly Half Moon Sign-superimposed densities of glenoid and humeral head in a normal shoulder; disappears in posterior dislocation

Hurricane Sign-Myocardial perfusion scan shows a

hurricane sign representing an artifact due to patient motion. Hot Cross Bun Sign-criss-cross pattern on T2W MRI in pons in patients with MSA-c, a neurodegenerative disease

Head Cheese Sign-combination of ground-glass opacity and mosaic perfusion on chest CT seen in hypersensitivity pneumonitis, DIP, sarcoid Hockey Stick Ureter (AKA Fishooking)-J-shaped appearance of distal ureter from enlargement of prostate and elevation of trigone usually in BPH I Index Ivory Vertebra-dense, white vertebral body essentially of normal shape, most often from osteoblastic prostate or breast ca mets or Paget Dz Incomplete Rim Sign-a partly sharply marginated, partly indistinct mass from its projection into an airfilled structure or atmosphere Incomplete Fissure Sign-concave edge produced by pleural fluid abutting an incomplete major fissure, usually on right side Inside Out Liver Sign-inversion of portal flow produces inside-out enhancement of liver secondary to hepatic vein occlusion Insular Ribbon Sign-blurring of the normal corticomedullary junction in the insular cortex as a sign of a middle cerebral artery infarct

Ivory Phalanx Sign-sclerosis of an entire digit, usually big toe, seen in psoriasis

J Index Jackstone Calculus-a bladder stone with jagged, irregular margins indicating formation in a trabeculated bladder; from "ball and jacks" game Juxtaphrenic Peak-tent-like projection of the medial hemidiaphragm seen with upper and sometimes middle lobe atelectasis J-shaped Sella-sella extends under anterior clinoid process and looks like J on side; seen in normals, hydrocephalus or optic chiasm glioma K Index Kidney Bean Sign-AKA coffee-bean; the shape of the grossly dilated rounded sigmoid colon in a sigmoid volvulus Knuckle sign-dilated pulmonary artery with abrupt tapering seen in occlusive disease like pulmonary embolism Keyhole sign-breast-AKA Noose Sign-MRI-early intracapsular breast implant rupture; presence of silicone both inside and outside implant shell fold

Keyhole sign-GU-on infant US, the appearance of distended bladder and dilated posterior urethra in post. urethral valves Kissing Ulcers-usually refers to gastric ulcers on apposing sides of the stomach in close proximity to each other L Index Lateral Femoral Notch Sign-an abnormally deep depression of the lateral femoral sulcus, site of impaction fracture asociated with an ACL tear Lead Pipe Colon-rigid, ahaustral appearance of colon classically seen with chronic ulcerative colitis Lead Pipe Fracture-combination of a greenstick and torus fracture in same bone of a child Lightbulb sign-the persistent appearance of the internally rotated humeral head in posterior dislocation of the shoulder Luftsichel sign-sickle-shaped, over expanded superior segment of LLL interposed between aortic arch and atelectatic LUL Lateral Capsular sign-avulsion adjacent to lateral tibial plateau indicating injury to lateral capsular ligament and ACL

Leontiasis Ossea-lion facies-facial deformity from bony overgrowth seen most often in polyostotic fibrous dysplasia Licked Candy Stick Sign-tapered appearance of metacarpals, phalanges and clavicles seen with psoriatic arthritis due to erosions Laminated Periosteal Reaction-multiple layers of new bone formed in sequence around cortex, producing an onionskin appearance Lambda Sign-Gallium uptake in the paratracheal and bilateral hilar region characteristic of sarcoidosis. Linguine sign-breast-MRI sign of intracapsular breast implant rupture; signal strands are the implant shell floating in silicone

M Index Molar Tooth Sign-appearance of perivesicular contrast on contrast-enhanced CT in extraperitoneal bladder rupture Moulage Sign-dilated loop of small bowel with effaced folds resembling tube into which wax has been poured; seen in sprue

Misty Mesentery Sign-infiltrative pattern in mesenteric fat seen with mesenteric panniculitis MacEwan Sign-displacement or obliteration of the pronator quadratus fat plane around wrist, usually from radial fracture Mercedes Benz Sign-tri-radiate appearance of air in gallstone seen on CT and plain films Maiden Waist Sign-medial deviation of ureters in retroperitoneal fibrosis Mickey Mouse Pelvis-outward flaring of the iliac wings that can be seen in Down syndrome Mickey Mouse Sign-increased radiotracer uptake on bone scan in pedicles and spinous process in Paget's disease N Index Napoleon Hat Sign-inverted hat-like appearance of L5 vertebra on frontal view in severe anterolisthesis of L5 on S1 Naked Facet Sign-lack of coverage of one facet, usually in cervical spine, by its subluxed partner, seen on CT and plain films

Nubbin Sign-On HIDA scan, there is no evidence of the radionuclide in the gallbladder except for a little nubbin representing the cystic duct with tracer. This is a sign of obstruction in the gallbladder neck. Nutcracker Fracture-compression fracture of cuboid between calcaneous and bases of 4th and 5thmetatarsals

O Index Onion Skin Periosteal Reaction-lamellar reaction from concentric layers of new growth seen in Ewing's, osteomyelitis, and osteosarcoma Omental Cake-plaque-like neoplastic infiltration of the greater omentum most often caused by stomach, colon or ovarian carcinoma Oil Droplets-multiple punched-out lytic defects seen in multiple myeloma

P Index Pawnbroker's Sign-bilateral hilar and right paratracheal adenopathy seen in sarcoid resembling 3 hanging balls of old Pawnbroker's Shops Pear-shaped Bladder-shape of urinary bladder from extrinsic compression from excess pelvic fat, fluid, blood, urine or adenopathy

Popcorn Calcification-flocculent, amorphous calcification in solid masses, frequently indicating smooth muscle calcification, e.g. fibroids Popcorn Calcification-breast-calcification due to hyalinization of fibroadenomas Pencil-in-Cup Sign-psoriatic erosions in which narrowed end of metacarpal or phalanx inserts into expanded end of adjacent bone Pencil Pointing-sharply tapered erosion of distal clavicle usually seen with rheumatoid arthritis Pseudo-Rigler's Sign-apparent visualization of both sides of bowel wall when two dilated loops of bowel abut each other Polka Dot Sign-thickened trabeculae seen on end on CT in vertebral body hemangiomas Pad Sign-bowel-impression on a loop of bowel by extrinsic mass or organ Pancake Kidney-fusion of both the lower and upper poles of the kidneys; AKA disc kidney Pedicle Sign-destruction of the vertebral pedicle, seen more with lytic metastatic disease than multiple myeloma

Pancake Vertebra-flattening of a vertebral body (vertebra plana) from a compression fracture as in eosinophilic granuloma Puckered Panniculus Sign-panniculus with central indentation from previous abdominal surgery Putty Kidney-calcified, end-stage kidney resulting from autonephrectomy due to renal tuberculosis Picket Fence Appearance-spiculated contour of small bowel with submucosal infiltration, as in hemorrhage or radiation Picture Framing-thickened cortex of a vertebral body with Paget's disease resembling a picture frame Pneumoarthrogram Sign-AKA vacuum joint-normal appearance of gasses (nitrogen) that come out of solution in a large joint from traction Pseudoumor-AKA Vanishing tumor-fluid in a fissure, usually minor, mostly seen in CHF-vanishes with reversal of failure Phantom Calyx Sign-absence of an expected renal calyx from TB, neoplasm or stricture

Puff of Smoke Sign-tangle of small collateral vessels seen at cerebral angiography-in Moyamoya Dz-from central vessel occlusion Pie-in-the-Sky Sign-elevation of the urinary bladder by a large pelvic hematoma also suggests urethral injury Piece of Pie Sign-triangular appearance of lunate in frontal projection of wrist in lunate dislocations Pyloric Tit Sign-outpouching created on lesser curve by distorted muscle in hypertrophic pyloric stenosis Panda Sign-Gallium uptake in the lacrimal, parotid and submandibular glands characteristic of sarcoidosis. Pedestal Sign-sign of loosening of prosthetic femoral stem in cementless total hip arthroplasty Ptotic (AKA Fallen) Lung Sign-drooping of the lung on chest x-ray or CT to dependent part of chest described with fracture of the bronchus R Index

Rugger Jersey Spine-sclerotic superior and inferior endplates of vertebrae from secondary hyperparathyroidism from renal disease Rat-tail Sign-irregularly marginated tapering of esophagus in achalasia AKA Bird's Beak Sign; or of bronchus and biliary duct in carcinoma Rigler's Sign-visualization of both sides of bowel wall on CT and radiography in presence of a pneumoperitoneum Rat-bite Sign-sharply marginated, overhanging bony erosions usually associated with gouty arthritis Rolled Edge Sign-the dense perimeter of a calcified pleural plaque seen en face, especially with asbestos exposure Rachitic Rosary-enlarged costochondral junctions of the ribs in rickets resembling a string of rosary beads Reverse Pulmonary Edema-peripheral airspace disease with sparing of central lung esp in pulmonary infiltrates with eosinophilia Reverse 3 Sign (GI)-appearance of inner margin of duodenal loop from enlarged head of pancreas with tethering at ampulla

Rice Grain Calcifications-elongated oval-shaped, soft tissue calcifications the size of rice grains seen in cysticercosis Ribbon Ribs-thinned and attenuated appearance of ribs usually seen with neurofibromatosis Reversed Halo Sign-rounded ground-glass attenuation circled by ring of denser consolidation on CT-seen with cryptogenic organizing pneumonia Reverse Hamburger on Bun Sign-inverted appearance of facet joints on CT and MRI in facet joint dislocation Rod-like Calcifications-breast-calcifications from ductal secretions that form along orientation of the ductal system Rim Sign-Nucs-In this HIDA scan, uptake is seen in the area of the superior aspect of the gallbladder. This is a sign of pericholecystic hepatic activity representing late acute cholecystitis. Ring-Around-the-Artery Sign-air surrounding right pulmonary artery on lateral chest from pneumomediastinum Ring Sign (papilla)-on CT urogram or IVP, contrast outlining a detached papilla in papillary necrosis, often triangular in shape

S Index Sandwich Sign-adenopathy most often from mesenteric lymphoma is the "bun" that encases the mesenteric vessels and fat (filling) Scalloped Vertebra-anterior: pressure usually from aneurysm; posterior: from spinal tumors, neurofibromatosis or communicating hydrocephalus Sentinel Loop-one or two dilated loops of small bowel which may indicate the presence of an irritative process in the region, e.g., inflammation Spine Sign-paradoxically increased density of lower spine seen on lateral chest x-ray indicative of a lower lobe process such as pneumonia Snowman Sign-dilated vertical vein and SVC form head of snowman in Type 1 supracardiac Total Anomalous Pulmonary Venous Return; RA is "body" String of Beads Sign-multiple, linearly-arranged small pockets of air in a fluid-dilated small bowel loop seen with mechanical SBO Scimitar Sign-anomalous draining pulmonary vein along right heart border that usually empties into IVC; shaped like Turkish sword Silver Fork Deformity-appearance of acutely dorsally angulated wrist from distal radius fracture seen in Colles fx

Snowstorm Appearance-innumerable small pulmonary nodules frequently associated with metastatic carcinoma from thyroid Small Bowel Feces Sign-on abdominal CT, heterogeneous solid material containing air bubbles in dilated small bowel from SB obstruction Silhouette Sign-the process whereby two substances of the same density which touch each other blur the edges between them Scottie Dog-the appearance of the pedicle, transverse process and facets on an oblique lumbar spine x-ray Shaggy Esophagus-irregularly ulcerated appearance of the lumen of the esophagus described with Candidiasis Spinnaker Sail Sign-abnormal elevation of lobes of the thymus seen with pneumomediastinum; thymic sail sign is normal Snowcapping-dense appearance of humeral head from avascular necrosis thought to resemble snow on mountain top Snowtorm Pattern-breast-ultrasound sign of breast implant rupture; silicone granulomata produce multiple echoes in extracapsular breast silicone leaks

Shmoo Sign-appearance of prominent, rounded left ventricle and dilated aorta likened to the Shmoo in L'il Abner comic Sister Mary Joseph Sign-nodule bulging at umbilicus as a result of metastatic disease in the abdomen, most often from GI tract and ovary Shepherd's Crook Deformity-coxa vara with outward bowing of proximal femur in fibrous dysplasia or osteogenesis imperfecta Soft Tissue Rim Sign-CT-edema of the ureteral wall surrounding an impacted ureteral stone; aids in DDX from phlebolith Stack of Coins-dilated small bowel with little or no infiltration of the submucosa, as in scleroderma or sprue String Sign-very thin luminal contrast usually in terminal ileum from spasm and eventually fibrosis, most often seen in Crohn disease Sunburst Periosteal Reaction-highly aggressive spiculated reaction indicating a malignancy such as osteosarcoma Steeple Sign-croup-smoothly tapered air shadow seen at level of larynx on AP chest or neck because of subglottic swelling

Salt and Pepper Skull-multiple, small areas of resorption of skull in hyperparathyroidism results in mottled appearance like salt and pepper Signet Ring Sign-pulmonary-dilated bronchus is larger than accompanying pulmonary artery, seen on chest CT in bronchiectasis Split Pleura Sign-on CT, contrast-enhanced visceral and parietal pleurae divide around a less-dense empyema Stepladder Sign-breast-US sign of intracapsular breast implant rupture. Multiple parallel horizontal echogenic lines within collapsed implant shell String of Beads (IR) Sign-corrugated or pleated appearance of artery affected by fibromuscular hyperplasia Splled Teacup Sign-appearance of volar displaced concave surface of lunate in a lunate dislocation Spoke Wheel Appearance-angiographic appearance of vessels originally thought 2nd to oncocytoma but also seen with renal cell carcinoma Sausage Digit-fusiform swelling of a single digit resembling a cocktail sausage, classically seen in psoriasis Soap Bubbly Appearance-expansile, septated appearance of solitary plamacytoma or renal or thyroid cell carcinoma metastases

Sandwich Vertebra-appearance of vertebra in osteopetrosis due to increased density of endplates Spotted Nephrogram-patchy enhancement of renal parenchyma seen on CT, MRI or angio as result of small vessel occlusion, e.g. vasculitis Spaghetti Sign-linear filling defect representing blood clot in the bladder on CT or urogram Stripe Sign-on perfusion lung scan, a perfusion defect with a stripe of normally perfused lung at pleural surface; mitigates against PE Saber Shin Deformity-marked anterior bowing of tibia seen in congenital syphilis, Paget disease and rickets Saber Sheath Trachea-marked coronal narrowing and sagittal widening of intrathoracic trachea, esp in COPD Stocking Glove Sign-In this bone scan, there is a stocking glove sign on the right hand. This represents uptake in the bony structures of the hand as a result of arterial injection. String-of-pearls Sign-Nucs-Increased radiotracer activity on bone scan in linear pattern in several ribs representing traumatic injury versus metastatic disease which would have a scattered appearance.

Six-Point Star Sign-In this thyroid scan, the six point star sign represents an artifact seen as a result of septal penetration. Swiss Cheese Appearance-multiple fenestrations in ventricular septum usually seen in a muscular VSD

T Index Teacup Calcification-breast-curvilinear, teacup-shaped calcifications from dependent settling with cystic dilatation; seen in milk of calcium esp.in the MLO view Terry Thomas Sign-widening of distance between the scaphoid and lunate (>3mm) on PA view from ligament disruption-AKA David Letterman sign Tree-in-bud pattern- bronchiole filled with fluid resembling a branching tree with buds; seen in airway disease; common in endobronchial spread of infection (e.g. TB) Thumbprinting-indentation in contrast or air-filled bowel lumen caused by submucosal infiltration and resembling a thumbprint; eg ischemia Thumb Sign-enlarged epiglottis in epiglottitis which, instead of its usual thin fingerlike projection, is stubby, like the thumb

Thymic Sail Sign-normal appearance of thymus gland as it contacts minor fissure; spinnaker sail sign is abnormal Target Sign-x-sectional enhanced mucosa and serosa with more lucent central submucosa due to edema or inflammation of bowel wall Trough Sign-linear fracture of the anterior and medial portion of the humeral head from a posterior shoulder dislocation Talar Beak-upward bony projection from anterosuperior aspect of talus associated with tarsal coalition Target Calcification-bulls-eye calcification in center of pulmonary histoplasmoma Tooth Sign-degenerative enthesophyte formation on superior aspect of patella as seen on axial or skyline (sunrise) view Teardrop Sign (ankle)-soft tissue anterior to ankle joint on lateral radiograph indicating a joint effusion Three Sign (cardiac)-appearance of aorta, coarctation and post-stenotic dilatation in a coarctation of the aorta Tram Tracking-tube-like parallel lines representing thickened bronchial walls usually seen with bronchiectasis

Trolley Track Sign-combination of bamboo spine and ossification of the interspinous ligaments in ankylosing spondylitis Tubular Artery Sign-air outlining the ascending aorta, aortic arch and major branches of aorta in pneumomediastinum Tumbling Bullet Sign-a bullet which changes its orientation within a solitary bone cyst presumably caused by the bullet Threads and Streaks Sign-angiographic or MR appearance of vascularized tumor thrombus seen with renal cell carcinoma Thread-and-streak sign-early linear appearance of portal vein on angiography or CT usually from enlarging hepatocellular carcinoma Tulip Bulb Sign-appearance of dilated aortic root with sinotubular ectasia, especially in Marfan's syndrome

U Index Upside Down Stomach-organoaxial rotation of stomach in gastric volvulus resulting in reversed positions of lesser and greater curvatures

V Index Vanishing Tumor-AKA Pseudotumor-fluid in a fissure, usually minor, mostly seen in CHF-vanishes with reversal of failure Vacuum Disk Sign-abnormal gas in the disk in degenerative disk disease; vacuum joint sign is normal Vacuum Joint Sign-normal appearance of gasses (nitrogen) that come out of solution in a large joint from traction W Index Westermark's Sign-focal or regional pulmonary oligemia seen occasionally distal to occlusive thromboembolic disease in the lung Whiskering-irregular bone growth at sites of tendinous insertions; enthesophytes, seen in DJD, DISH and spondyloarthropathies Waterbottle Heart-globular shape of heart from a large pericardial effusion Wimberger's Ring Sign-denser white line of calcification encircling the osteoporotic epiphyses in scurvy

Wimberger's Sign-bilateral focal destruction of the medial aspect, proximal tibial metaphyses; pathognomonic for congenital syphilis Water Lily Sign-collapse of inner wall of hydatid cyst into a partially air-filled, partially fluid-filled cavity Whirlpool Sign-clockwise swirling of Sup. Mesenteric V. around Sup. Mesenteric A. on transverse abdominal US in infants with midgut volvulus

Y Index Yin Yang Sign-swirling blood flow in a pseudoaneurysm on US or partly thrombosed aneurysm on contrast CT, resembling ancient Chinese symbol