IMPORTANT XRAYS

Apple Core lesion — signifies annular carcinomas of the colon—looks like an apple core or napkin ring(see below) due to circumferential narrowing of the lumen, noted on contrast studies.

Bamboo Spine — fused spinal segments with their syndesmophytes look, on radiographs, similar to bamboo stalks—classically associated with ankylosing spondylitis.

Bird's Beak — noted on Upper GI with contrast, a dilated upper/middle esophagus with an abrupt taper to exceptionally narrowed lumen, typical of achalasia.

Boot-shaped Heart — due to RVH, the LV is lifted above the edge of the diaphragm, forming the “toe” of the boot. Classic for Tetralogy of Fallot.

Bat's Wing/Butterfly — this appearance on CXR is classically associated with CHF and resultant pulmonary edema.

Cobblestone appearance — this sign is produced on barium studies due to ulcerative pockets, usually in the terminal ileum, indicative of Crohn's.

Codman's Triangle — a triangle on plain film of extremities that signifies reactive bone, classically associated with osteosarcoma, or other infectious/hemorrhagic process that causes periosteal elevation.

Coin lesion — solitary pulmonary nodule; may be cancer or granuloma.

Cutter lesions — metastatic lesions to bone cortex, or Paget's. Crescent sign — classic sign of avascular necrosis, femoral head.

Egg-on-a-string — a large, ovoid-shaped heart on newborn CXR, classically signifying complete transposition of the great vessels with intact ventricular septum.

Ground glass — a “white-out” on CXR, usually PCP pneumonia or ARDS.

Hampton's Hump — a peripheral triangle, usually near pleural edges, classically PE.

Honeycomb lung — used to describe any pathologic process that causes radiographic appearance of multiple small, thick-walled cystic spaces; e.g. pulmonary fibrosis.

Lead pipe sign — classic narrowing of bowel lumen, with loss of haustra—Ulcerative Colitis.

Napkin Ring sign — see Apple core lesion above; pathology identical, but lumen more narrowed.

Onion-skinning — layered look of periosteum in Ewing's Sarcoma.

Rachitic Rosary — this is a “string of beads” appearance on x-ray, a thickening of costochondral margins that is noted in Ricketts(Vit. D Deficiency).

Sail sign (elbow) — fat pad noted on plain film, indicative of elbow disclocation.

Sail Sign (Chest X ray) — Thymic shadow in children seen in chest X ray.

Scotty dog(collar) — on posterior oblique, the lumbar vertebrae look like a Scottish terrier. The neck is the pars interarticularis, and a break(a collar) noted there indicates spondylolysis.

String sign — thin, slightly irregular shadow in narrowed lumen of ileum, suggestive of Crohn's. Silhouette sign — obliteration of cardiovascular silhouette due to adjacent disease, ie pneumonia, TB, etc.

Stepladder appearance — distended bowel loops, often indicative of obstruction, usually SBO.

Sunburst appearance — “clouds, clumps, and consolidated rays” of tissue emanating from bone cortex, or within bony structures, indicative of osteosarcoma.

Thumb(print) sign — on lateral c-spine, an enlarged epiglottis appears as a “thumb”—epiglottitis.

Westermark's sign — abrupt end to a pulmonary vessel, signifying oligemia or PE.