GIT

Radiological Signs

KSMA AKHUNBAEV I.K.

R A D I O LO GY D E PA R T M E N T
M U S A E VA N . S .
Gastrointestinal Radiology Signs
Esophagus:
“bird’s beak” sign
“rat-tail” sign
“corkscrew” sign
 esophageal diverticula
“Bird’s beak” sign

It describes a dilated
proximal esophagus with
a smooth-tapered, distal
esophagus at the level of
the esophageal hiatus in
the setting of achalasia
 “Rat-tail” sign

Frontal view of a barium swallow displaying a distended distal

esophagus and only a small amount of contrast material passing into the
stomach in a patient with achalasia
“Corkscrew” sign

The “corkscrew” sign is

the manifestation of
lumen-obliterating,
nonperistaltic abnormal
contractions which occur
in diffuse esophageal
spasm, a rare
esophageal motility
disorder
Esophageal Diverticula

Esophageal
diverticula occur in
three locations:
the neck,
around the carina
 and just above the
diaphragm.
Hiatal Hernia
The radiologic findings of hiatal hernia include
a bulbous area
failure of the esophagus to narrow,
multiple gastric folds above the diaphragm
 and circumferential filling defect in the distal esophagus called a
Schatzki ring.
Gastroesophageal Reflux (GERD)
GERD may be evident during fluoroscopy when barium is seen to
move from the stomach retrograde into the esophagus
Gastroesophageal reflux (GERD) is the most common cause of
esophagitis.
Reflux esophagitis findings:
mucosal folds are thickened, irregular
ulcers and erosions
strictures
Esophageal Carcinoma
Esophageal carcinomas may appear in
one or more of several forms, including
 an annular-constricting lesion,
 polypoid mass,
 a superficial, infiltrating lesion or
ulceration,
 and irregularity of the wall.
Stomach and Duodenum
 The lumen of the stomach is most often studied by upper
endoscopy
 The wall thickness and structures outside of the stomach are
studied by CT examination of the abdomen with oral contrast.
 Nevertheless, biphasic-contrast (barium meal) examinations,
which include a study of the esophagus, stomach, and duodenum,
remain a sensitive, cost-effective, readily available, and noninvasive
examination.
Stomach Radiological signs
Gastric ulcer
Bull’s eye lesions
Ram’s horn
Leather bottle stomach
Gastric ulcer

Most ulcers occur on the lesser

curvature or posterior wall in the
region of the body or antrum.
 About 95% of all gastric ulcers
are benign.
 The other 5% will represent
ulcerations in gastric
malignancies
Gastric Carcinoma
Endoscopy is regarded as the most sensitive and specific diagnostic
method in patients suspected of harboring gastric cancer.
 Endoscopy allows direct visualization of tumor location, the extent
of mucosal involvement, and biopsy for tissue diagnosis
 But radiological methods, as Fluoroscopy and CT examination, are
often the initial study that raises suspicion for gastric carcinoma,
besides being used in the staging of the disease.
Bull’s eye lesions

Lesions within the stomach forming central collections of oral

contrast within ulcerated intramural masses can produce a bull’s eye
appearance
This bull’s eye appearance has been described with many disease
processes including:
 Gastric metastatic lesions from melanoma and lymphoma
 Kaposi’s sarcoma and carcinoid tumors
Ram’s horn

Crohn’s disease of
the stomach leads to
gastric deformity,
causing a tubular
shape, conical
narrowing, and
limited distensibility
of the stomach
Comb sign
The “comb sign” is seen in
the presence of Crohn’s
disease.
 This sign is observed on
contrast-enhanced CT or
magnetic resonance imaging
(MRI) scans
Target sign
The target sign is classically seen in
patients with Crohn’s disease.
 It can, however, be seen in many other
conditions
GVHD
 ischemic bowel
 intramural haemorrhage
 vasculitides such as Henoch-Schonlein
purpura
 and pseudomembranous colitis
Leather bottle stomach

The stiff, nondistensible

gastric wall gives the stomach
a leather bottle appearance,
also known as linitis plastic can
be seen in scirrhous
adenocarcinoma
Duodenal ulcers
Duodenal ulcers are two to three times more common than gastric
ulcers.
Almost all duodenal ulcers occur in the duodenal bulb, the majority
on the anterior wall of the bulb.
Complications of duodenal ulcers, best demonstrated by CT,
include obstruction, perforation ,penetration, or hemorrhage
Duodenal Radiological Signs
Duodenal Ulcer
Duodenal diverticula
Windsock sign
Double bubble sign
Duodenal Ulcer
Duodenal diverticula
Diverticula are seen as saccular
outpouchings from the
duodenum that may contain gas,
fluid, contrast or food debris or
any combination of these.
They often contain a gas-fluid
or gas-contrast level
Diverticulosis
Windsock sign

The windsock appearance is formed by passive elongation of the

intraluminal diverticulum due to continual peristalsis of the
duodenum
Double bubble sign
The double bubble sign
indicates the presence of
duodenal obstruction
The intrinsic causes include
 duodenal webs,
 duodenal atresia,
and duodenal stenosis.
Small Bowel signs
“whirlpool” sign
“string of pearls” sign
“stack of coins” sign
 string sign
 ribbon sign
“Whirlpool” sign
The whirlpool appearance
represents the swirling pattern of
the gut and the superior
mesenteric vein as they wrap
around the superior mesenteric
artery (SMA) in a clockwise
rotation
The shortened mesentery
predisposes to volvulus that may
result in bowel obstruction.
“String of pearls” sign

The “string of pearls” sign

indicates the presence of a
small-bowel obstruction.
It represents a row of small gas
bubbles oriented in a relatively
linear fashion within the
abdomen on plain films
“Stack of coins” sign

The “stack of coins” sign typically indicates the presence of a small-bowel

hematoma.
Other causes that may lead to the stack of coins sign include:
 idiopathic thrombocytopenic purpura,
 pancreatitis,
 pancreatic cancer,
lymphoma,
 myeloma
String sign
In the setting of Crohn’s
disease, often becomes markedly
stenotic secondary to bowel-wall
inflammation and fibrosis.
This results in the lumen of this
portion of the small bowel
resembling a piece of string on
plain radiographs after ingestion
of high-density oral contrast
material
Ribbon sign

Marked bowel-wall
thickening caused by
graft-versus-host
disease (GVHD) can
occur both in the small
and large bowel.
Apple core sign (colon)
The apple core sign, also
known as the napkin ring
sign (bowel), is most
frequently associated with
constriction of the lumen of
the colon by a stenosing
annular colorectal
carcinoma
Hepatobiliary abnormalities
CT evaluation of liver masses is usually done with a combination of
scans obtained before and after intravenous contrast injection.
 Post-contrast scans are obtained in two phases:
 one is done quickly (hepatic arterial phase),
 a second is done about a minute later (portal venous phase)
This combination of three separate scans done without contrast,
then during the arterial phase followed by the venous phase, is
called a triple-phase scan
Triple-phase computed tomography scan of the liver evaluate
hepatocellular carcinoma
Fatty liver
The fatty infiltration may
be
 diffuse or focal,
and focal lesions may be
 solitary or multiple.
Fatty Liver USG
Hepatic hydatid cyst
Starry sky appearance of Liver (usg)
A starry sky appearance refers to
appearance of the liver
parenchyma in which there are
bright echogenic dots throughout a
background of decreased liver
parenchymal echogenicity.
Although usually associated with
acute hepatitis
References
http://radiologyreviewarticles.com/gi/gastrointestinal-radiology-signs/
https://appliedradiology.com/Articles/part-1-classic-signs-in-gastrointestinal-radiology.aspx
https://radiologykey.com/recognizing-gastrointestinal-hepatic-and-urinary-tract-abnormalities/
https://radiopaedia.org/articles/starry-sky-appearance-ultrasound-1?lang=us
Learning Radiology Recognizing the Basics by William Herring