This document discusses various "food signs" in radiology where imaging findings resemble different foods. It provides examples of signs named after fruits like the apple core sign in colon cancer and berry aneurysms. Other signs are named after vegetables, meats, pastas, desserts and dishes. Examples described include the banana sign in neural tube defects, sausage digit in psoriatic arthropathy, and eggshell calcification in lymph nodes. Recognition of these memorable signs aids diagnosis and differential diagnosis. While sometimes fanciful, they improve pattern recognition and radiological interpretation.
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Food signs in radiology pp ta
1. By Fathima Hasan Mohamed
Senior Radiographer
Date: 22/08/2016
Food Signs in Radiology
2. 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.
3. 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.
4. Selections from the Buffet of Food Signs in
Radiology
Fruits:
• Apple core lesion
• Berry aneurysm
• Pear-shaped bladder
• Lemon sign
• Banana sign
5. Vegetable:
• Celery stalk metaphysis
• Onion skin periosteal reaction
Meat, fish, and egg dishes:
• (Hamburger sign, sausage digit, vertebral
scalloping, eggshell calcification)
Selections from the Buffet of Food Signs in
Radiology
6. Pasta, rice, grains, and bread (carbohydrates):
• linguine sign, rice grain calcification, miliary
shadowing, cottage loaf sign
Desserts, 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
7. 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
8. 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.
9. Apple Core Lesion
partially eaten
apple
Double contrast barium enema showing
apple core lesion due to carcinoma of colon
13. 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.
16. 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.
18. 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 .
20. 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.
25. 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.
26. Celery stalk Metaphysis
Celery stalk X-ray left hip showing vertical
Striations in
femoral neck in Osteopathia
Striata
X-ray right knee in
Osteopathia Striata
27. 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
28. Onion Skin Periosteal Reaction
Onion skin showing whorls
X-ray tibia revealing lamellated periosteal
reaction on lateral aspect in Ewing’s
sarcoma.
multiple concentric parallel
layers of new bone
adjacent to the cortex
29. 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.
30. Hamburger Sign
Hamburger
Axial CT Scan of a vertebra revealing
presence of hamburger sign on right
side and loss of
hamburger sign on left side
indicating flexion distraction
injury.
31. 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).
34. 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.
37. 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).
38. Food Signs in the Chest Diseases
Miliary Shadowing in
Tuberculosis Millet seed
41. 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.
47. 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.
49. 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.
51. 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
53. 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.
55. 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
56. Licked Candy Stick Appearance
Candy sticks
X-ray both feet showing tapered
metatarsal
ends in psoriasis
57. , 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.
59. Cottage Loaf Sign
Cottage loaf bread, a traditional bread in U.K
The MRI appearance of the partially
herniated liver through the ruptured right
Hemidiaphragm.
60. 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.
62. 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.
65. 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.
67. 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.
68. Dagger sign in Ankylosing Spondylitis
Single central radiodense line
related to ossification of
supraspinous and interspinous
ligaments which is called
dagger sign.
70. 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
71. 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!
