food signs in radiology pp ta
TRANSCRIPT
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By Fathima Hasan Mohamed
Senior Radiographer Date: 22/08/2016
Food Signs in Radiology
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Objectives
• To provide the information and learn the characteristic radiological signs resembling various food items.
• Discuss and illustrate the radiologic signs of a number of diverse conditions whose classic radiologic manifestations resemble various types of food.
• Descriptive “food signs” are highly memorable and easily recognizable and allows a confident diagnosis on the basis of imaging findings alone or can narrow down the differential diagnosis.
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Introduction
• Radiologists have unique skills of observation and description
• Pattern recognition is one of the techniques used in the interpretation of radiographs, and this skill improves with experience.
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Selections from the Buffet of Food Signs in Radiology
Fruits:• Apple core lesion• Berry aneurysm• Pear-shaped bladder• Lemon sign• Banana sign
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Vegetable:• Celery stalk metaphysis• Onion skin periosteal reactionMeat, fish, and egg dishes:• (Hamburger sign, sausage digit, vertebral
scalloping, eggshell calcification)
Selections from the Buffet of Food Signs in Radiology
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Pasta, rice, grains, and bread (carbohydrates):• linguine sign, rice grain calcification, miliary
shadowing, cottage loaf signDesserts, cakes, and candy:• Donut sign, omental cake, pancake vertebra,
honeycomb lung, popcorn calcification, licked candy stick appearance
Selections from the Buffet of Food Signs in Radiology
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Dishes, cutlery, condiments:• Diffuse idiopathic skeletal hyperostosis [DISH]• Champagne glass pelvis• Dinner fork deformity• Salt and pepper calvaria• Coffee bean sign
Selections from the Buffet of Food Signs in Radiology
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Food Signs in Gastrointestinal Diseases
Apple Core Lesion
• The annular carcinoma of colon produces focal circumferential thickening of the bowel wall, narrowing of colonic lumen, associated with shouldering.
• On barium examination, this gives rise an appearance of the affected colon similar to the partially eaten apple.
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Apple Core Lesion
partially eaten apple
Double contrast barium enema showingapple core lesion due to carcinoma of colon
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Apple core lesion
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Apple core lesion
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Apple core lesion
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FOOD SIGNS IN BRAIN DISORDERS
• Berry Aneurysm• The appearance of the intracranial saccular
aneurysm on CT scan may resemble the size and shape of a berry hence termed berry aneurysm. They are congenital and characteristically occur at points where arteries bifurcate.
• It may occur in isolation or in association with polycystic kidneys or coarctation of aorta.
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Berry Aneurysm
Berries.
CT brain showing Berry aneurysm.
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Berry aneursym
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Banana Sign• The banana sign, is one of the many notable fruit inspired
signs.• The banana-appearance of the cerebellum on the antenatal
ultrasound is due to downward traction of the spinal cord and brainstem in neural tube defects hence giving the name banana sign.
• It is also seen in the majority of fetuses with spina bifida, but disappears after 24 weeks. It is only rarely seen in a normal fetus.
• There is very frequent concurrent hydrocephalus.• The same condition also gives rise to the lemon sign.
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Banana Sign
BananaAntenatal US of fetal head showing bananasign in the posterior fossa.
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Lemon Sign
• The appearance of the fetal cranial vault on antenatal ultrasound resembling lemon is an excellent indicator for open spina bifida.
• The lemon sign refers to an abnormally shaped fetal head seen at antenatal US performed during the second trimester. The cranial vault appears lemon-shaped in axial cross section because the frontal bones are flattened or concave .
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Lemon Sign
Lemon Antenatal US of cranium showing lemon sign
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Food Signs in Urogenital Diseases• Pear-shaped Bladder• The bladder assumes the shape of a pear
when it undergoes extrinsic compression due to excess tissue in the pelvis.
• The causes for the pear-shaped bladder include pelvic lipomatosis, pelvic hematoma, pelvic collection, pelvic masses, bilateral pelvic muscle hypertrophy or lymphadenopathy.
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Pear-shaped Bladder
Pears
Cystogram showing pear-shaped bladder
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Pear shaped bladder
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Pear shaped bladder
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Pear shaped bladder
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Celery stalk Metaphysis
• This is a term referring to vertical striations in the metaphysis of long bones or pelvis produced by the dysplastic bone disease like osteopathia striata
• This is an asymptomatic condition and the radiological picture resembles with the Celery stalk, a vegetable used in salad.
• Similar picture may also be seen in congenital rubella infection.
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Celery stalk Metaphysis
Celery stalk X-ray left hip showing vertical Striations infemoral neck in Osteopathia Striata
X-ray right knee in Osteopathia Striata
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Onion Skin Periosteal Reaction
• In an aggressive bone lesion like acute osteomyelitis, Ewing’s sarcoma or osteosarcoma, the successive deposition of periosteal layers gives a lamellated or onion skin appearance on plain films.
• Lamellated - Onion-skinning due to successive layers of periosteal development
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Onion Skin Periosteal Reaction
Onion skin showing whorls
X-ray tibia revealing lamellated periostealreaction on lateral aspect in Ewing’s sarcoma.
multiple concentric parallel layers of new bone adjacent to the cortex
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Hamburger Sign
• Normally, at axial CT, the vertebral facet (apophyseal) joint space looks like a hamburger
• When the facet joint is dislocated, the articular facets become uncovered, or naked, also called "naked facet sign”.
• This CT sign is characteristic of a flexion-distraction injury and indicates severe ligamentous disruption and spinal instability.
• It may be either unilateral or bilateral depending on whether facet dislocation is unilateral or bilateral.
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Hamburger Sign
Hamburger
Axial CT Scan of a vertebra revealingpresence of hamburger sign on right side and loss ofhamburger sign on left side indicating flexion distractioninjury.
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Sausage Digit• Sausage is a minced and seasoned meat stuffed into
cylindrical case of animal tissue frequently eaten in Europe.
• The term sausage digits refer to the clinical and radiologic appearance of diffuse fusiform swelling of digits due to soft-tissue inflammation from underlying arthritis or dactylitis .
• The most common cause of sausage digit is psoriatic arthropathy.
• Other causes include osteomyelitis, sickle cell anemia, sarcoidosis, and tuberculous dactylitis (spina ventosa).
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Sausage Digit
• .Sausages
• Bangers and mash Psoriatic hands, resembling sausages X-rays finger
showing soft tissue swellingresembling sausage digit
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Sausage digit
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Eggshell Calcification
• Eggshell calcification of nodes consists of shell-like calcification in the periphery of the node.
• Eggshell calcification of lymph nodes occurs in up to 5% of cases of silicosis.
• The hilar nodes are predominantly involved, but mediastinal, cervical, and intraperitoneal nodes may also be affected.
• Eggshell calcification has also been observed following treatment for lymphoma; the calcifications appear 1–9 years following radiation therapy.
• Eggshell calcification is occasionally observed in patients with sarcoidosis and is usually associated with advanced pulmonary disease.
• Coal worker pneumoconiosis, amyloidosis, and scleroderma are other conditions in which eggshell calcifications have been observed.
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Eggshell Calcification
Eggs
Chest PA showing eggshell calcification
Magnified lateral view
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Eggshell Calcification
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Food Signs in the Chest Diseases• Miliary Shadowing• The term miliary comes from "millet seed" popular
birdseed. On the Chest radiograph, a pattern of diffuse, tiny, well-defined nodules of 2–4 mm in size is called “miliary shadowing”. This pattern is often seen with pulmonary tuberculosis .
• The other differential diagnosis of miliary shadowing includes fungal infections, inhalational diseases, sarcoidosis, eosinophilic granuloma, and metastatic disease (particularly from thyroid tumors, melanoma, and choriocarcinoma).
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Food Signs in the Chest Diseases
Miliary Shadowing in Tuberculosis Millet seed
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Miliary Shadowing
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Miliary Shadowing
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Honeycomb Lung
• Honeycombing refers to an advanced stage of fibrosis in which normal lung parenchyma is replaced by cystic spaces of 5-10 mm . This is visible on Chest x-ray as well as on C T scan.
• The other common causes of honeycomb lung include pneumoconiosis, sarcoidosis, fibrosing alveolitis, scleroderma and rheumatoid diseases.
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Honeycomb Lung
Bee honeycombC T Scan showing Honeycombing
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Honeycomb Lung
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Honeycomb Lung
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Honeycomb Lung
Honeycombing in pneumoconiosis
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Pasta
Fettuccine with pesto Not quite linguine but close . Lemon linguine
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linguine sign
• After implantation of a silicone or saline breast implant, a fibrous capsule (scar) forms around the implant shell. In an intracapsular rupture the contents of the implant are contained by the fibrous scar while the shell appears as a group of wavy lines.
• This has been termed the “Linguine sign” and has been most commonly described with MR imaging. Here, the same findings are seen on CT imaging in a patient with bilateral ruptured saline implants.
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linguine sign
Breast MRI showing the linguine sign indicating intracapsular implant rupture.
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Rice Grain Calcification
• Calcified Cystiserci within the muscles produce ovoid flecks of calcification parallel to the long axis of muscles and resembling grains of rice.
Rice grains.
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Rice Grain Calcification
X-ray both knees showing bilateral rice grainsoft tissue calcifications around the knees
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Doughnut sign
• Doughnut sign refers to the imaging finding that resembles a doughnut. Circumferential thickening of the bowel wall in carcinoma of the colon and inflammatory bowel disease
• resembles an appearance similar to that of the doughnut.
Doughnut
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Doughnut sign
CT Scan pelvis showing Doughnut sign (arrow) inInflammatory bowel disease.
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Pancake vertebra
• A vertebra plana or pancake vertebra is the term given when a vertebral body has lost almost its entire height anteriorly and posteriorly, representing a very advanced crush fracture.
• It is caused by trauma in normal vertebra or collapse of vertebral body in pathological spine like metastases, multiple myeloma, lymphoma, haemangioma, eosinophilic granuloma or osteogenesis imperfecta.
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Pancake vertebra
Pancake
Reconstructed CT showing vertebral compression
MRI showing vertebral plana
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Licked Candy Stick Appearance
• The term licked candy stick appearance refers to tapering of the tips of the metacarpal bones, metatarsal bones, phalanges, or clavicles and is usually associated with:
• psoriatic arthropathy• rheumatoid arthritis• leprosy
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Licked Candy Stick Appearance
Candy sticks
X-ray both feet showing tapered metatarsalends in psoriasis
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, Popcorn calcification• Cartilaginous tumors (such as osteochondromas,
enchondromas, and chondrosarcomas) may produce irregularly shaped calcifications within their matrix that resemble popcorn on imaging studies.
• These "popcorn calcifications" can usually be distinguished from the "mashed potato," or cloudlike, ossific matrix of bone-forming tumors such as osteosarcomas.
• The term "popcorn calcification" has also been used to describe the lucent areas with sclerotic margins seen in the metaphyses and epiphyses of patients with osteogenesis imperfecta.
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Popcorn calcification
Popcorns
13 mm lung nodule with "popcorn" calcification.
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Cottage Loaf Sign
Cottage loaf bread, a traditional bread in U.K
The MRI appearance of the partiallyherniated liver through the ruptured rightHemidiaphragm.
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Coffee-bean sign
• Coffee bean sign is a characteristic sign of sigmoid volvulus and consists of a greatly distended, air-filled loop of sigmoid colon extending from the pelvis at abdominal radiography.
• The apposed medial walls of the dilated bowel form a distinct oblique line that resembles the cleft of a coffee bean.
• The “coffee bean” arises from the pelvis and may be very large, with its apex often extending above the level of T10 to the left or right of midline.
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Coffee-bean sign
Case 1: with perforation
Sigmoid Volvulus
coffee bean
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Champagne glass pelvis
• The champagne glass pelvis is a helpful sign in achondroplasia which the iliac blades are flattened, giving rise to a pelvic inlet that resembles a champagne glass. The acetabular angles are increased, and the sacrosciatic notch is small.
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Champagne glass pelvis
Champagne glassX-ray pelvis in Achondroplasia
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Champagne glass pelvis
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Dinner fork deformity
• In Colles’ fracture, the distal radius is fractured and angulated dorsally, giving rise clinically and radiologcally to the “dinner fork deformity” at the wrist .
• This has typical resemblance to the dinner fork.
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Dinner fork deformity
Picture of dinner fork
Colles’ fracture showing dinner fork deformity
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Inspired signs
• Fruit inspired signs• Vegetable and plant inspired signs• Inanimate and object inspired signs• Weapons and ammunition inspired signs• Animal and animal produce inspired signs • May sound a little silly, but the radiology
literature is replete with signs, some more fanciful than others.
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Dagger sign in Ankylosing Spondylitis
Single central radiodense line related to ossification of supraspinous and interspinous ligaments which is called dagger sign.
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Animal inspired sign- Scotty dog sign
X-ray lumbar spine-Oblique view
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Conclusion
• The recognition and application of these food signs on imaging is highly helpful for the diagnosis of various diseases throughout the body.
• However, these radiological signs should be correlated with clinical and other relavant informations to reach the correct diagnosis
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Conclusion
• Recognition of these signs, served with an understanding of the relevant differential diagnosis and pathologies, will go a long way toward satisfying the radiologist's ever-present hunger for learning and thirst for knowledge.
• Bon apetit!
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References
• http://radiopaedia.org/