Accordion Sign-appearance (C.

difficile)
penampilan kontras oral yang terperangkap di antara lipatan kolon yang menebal
oleh edema submukosa, terutama pada kolitis C. difficile.

Abdominal Cocoon (Peritonitis)

AKA sclerosing encapsulating peritonitis; panjang usus terbungkus oleh membran
fibrocollagenous padat memberikan penampilan kepompong.

Air Crescent Sign (aspergillomas)

Air Crescent Tanda lucency berbentuk sabit sebagian mengelilingi massa dalam
rongga paru pada rontgen dada & CT; klasik, aspergilloma

Air Bronchogram Sign (pneumonia)

Bronkus bercabang hitam terlihat karena udara di sekitarnya, seperti pada
pneumonia

Angel Wing Appearance ( pulmonary edema )

AKA Bat Wing-pola edema paru yang melibatkan daerah perihilar dan korteks
paru-paru

Anteater's Nose Sign (tarsal coalition)

Foto proyeksi lateral kaki, anterior memanjang, proses superior calcaneus terlihat
pada koalisi tarsal

Aortic Nipple-bump
Aortic Nipple-bump disebabkan oleh vena interkostal superior kiri saat
mengelilingi di sekitar tepi luar aorta
Apple Core-appearance (carcinoma of the bowel/ colon)
karsinoma usus pembatas annular, biasanya pada kolon/usus besar, dengan
terlibatnya lumen.

Acorn cyst breast (Fatty Cyst )

Kista kompleks dimana echogenisitas dalam kista tsb disebabkan oleh sel-sel lemak
dan protein; juga dikenal sebagai Fatty Cyst

Absent Bow-Tie Sign (meniscal injury)

Absent Bow-Tie Sign-absence of normal bow-tie appearance of meniscus on
sagittal MRI of knee in bucket handle tears

Bat Wing Appearance (Pulmonary Edema)

Bat Wing Appearance-AKA Angel Wing-pattern of pulmonary edema which
involves perihilar regions and spares cortex of lung

Berry Aneurysm (Aneurisma otak)

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 (Paget disease)

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 (eosinophilic granuloma)

Beveled Edge Appearance-asymmetric erosion of the inner and outer tables of the
skull usually seen with eosinophilic granuloma
Bird's Beak Sign / Rat-tail Sign (Achalasia)
Bird's Beak Sign-AKA Rat-tail Sign; irregularly marginated tapering of esophagus
in achalasia

Bowler Hat Sign (polyps from diverticula)

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 (Pulmonary Microlithiasis)

Black Pleural Line-paradoxical appearance of pleura in pulmonary microlithiasis
because of innumerable dense calcifications in adjacent lung

Bird of Prey Sign (Achalasia)

Bird of Prey Sign-tapered barium column in sigmoid volvulus; Bird's beak sign in
achalasia

Boot-shaped Heart (Tetralogy of Fallot)

Boot-shaped Heart-shape of heart in Tetralogy of Fallot due to upturned apex from
RVH and concave pulmonary artery segment

Bowtie Appearance (Meniscal Injury)

Bowtie Appearance-of facets in the cervical spine on lateral view in unilateral
rotatory subluxation at and above the site of rotation

Bamboo Spine (ankylosing spondylitis)

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 (xanthogranulomatous pyelonephritis)

Bear Paw Sign-dilated renal calyces with normal renal pelvis seen in calculus
disease and xanthogranulomatous pyelonephritis

Boutonniere Deformity (Rheumatoid Artritis)

Boutonniere Deformity-hyperextension of distal interphalangeal joint and flexion
of proximal interphalangeal joint in RA

Brim Sign (Paget's disease)

Brim Sign-thickening of the iliopectineal line (pelvic brim) in Paget's disease

Boomerang Sign (Stroke)

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 (avascular necrosis)

Bite Sign-MSK-gouged-out defect due to collapse of bone in head of femur in
avascular necrosis

Bulging Fissure Sign (Klebsiella Pneumonia)

Bulging Fissure Sign-bulging of usually minor fissure from heavy,exudative
pneumonia like Klebsiella

Banana Sign (spina bifida and other neural tube defects)

Banana Sign-abnormal shape of the cerebellum from compression seen on MRI or
antenatal US in spina bifida and other neural tube defects

C Index

Carman Meniscus Sign (malignancy of gaster)

Carman Meniscus 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 (granuloma or hamartoma)

Coin Lesion-a solitary pulmonary nodule generally considered less than 3 cm in
size, most often a granuloma or hamartoma
Codman's Triangle (osteosarcoma)
Codman's Triangle-triangular elevation of periosteum from an aggressive, usually
malignant, bone tumor such as an osteosarcoma

Cotton Wool Appearance (Paget disease)

Cotton Wool Appearance-islands of poorly marginated sclerotic disease surrounded
by less dense skull in Paget disease

Cobra Head (ureteroceles)

Cobra Head Abnormality-rounded dilatation of distal ureter, surrounded by thin
lucent line, seen in patients with adult-type ureteroceles

Cobblestone Appearance (in Crohn's disease)

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

Coffee-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, hematogenously 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

Cupola Sign-arcuate lucency superimposed on lower thoracic spine on a supine

abdomen representing free air under the central diaphragmatic tendon

Cobblestone Pattern-hysterosalpingography-rounded filling defects from

intraluminal adhesions

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 Lateral Sulcus Sign-abnormally deep depression of the lateral condylopatellar

sulcus which can be an indirect sign of an ACL tear

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 hemarthrosis 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 Hallervorden-Spatz syndrome
Elephant-on-a-Flagpole Sign-appearance of a rounded extrarenal pelvis "sitting"
atop the ureter

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

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

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 Fishhooking)-J-shaped appearance of distal ureter from
enlargement of prostate and elevation of trigone usually in BPH

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 air-filled 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 cortico-medullary 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
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

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

Lateral Femoral Notch Sign-an abnormally deep depression of the lateral femoral
sulcus, site of impaction fracture associated 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

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

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 5th metatarsals

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

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

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

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"
Swan neck deformity-hyperextension of proximal interphalangeal joint and flexion
of distal interphalangeal joint, e.g. in rheumatoid arthritis

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

Snowstorm 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

Stepladder Appearance-multiple loops of small bowel in the left upper quadrant in a

mechanical small bowel obstruction

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

Spilled Teacup Sign-appearance of volar displaced concave surface of lunate in a

lunate dislocation

Spoke Wheel Appearance-angiographic appearance of vessels originally thought

secondary 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 plasmacytoma

or renal or thyroid cell carcinoma metastases

Sandwich Vertebra-appearance of vertebra in osteopetrosis due to increased density

of endplates

Stipple Sign-contrast in the interstices of a papillary GU lesion suggestive of

transitional cell tumors

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

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

Target Sign-US-hypertrophic pyloric stenosis-transverse image appearance of

thickened pylorus muscle

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

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

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

Yin Yang Sign-swirling blood flow in a pseudoaneurysm on US or partly

thrombosed aneurysm on contrast CT, resembling ancient Chinese symbol

Y Sign-characteristic shape of thecal sac compression in lumbar epidural

lipomatosis producing a stellate shape like a "Y