String sign is suggestive of:
Correct Answer: Hyperophic Pyloric stenosis (HPS)
Description: B i.e. Hyperophic Pyloric Stenosis Meconium ileus is small bowel obstruction secondary to sticky tenacious meconium d/ t deficiency of pancreatic secretions. It is the earliest clinical manifestation of cystic fibrosis. It usually presents with abdominal distension, bilious vomiting and failure to pass meconium within 48 hours. It has Bubbly/Froathy/Soap BubbleQ/Apple sauce appearanceQ d/t admixture of gas with meconium. Barium meal (swallow) appearance of Oesophageal Disorders Bird's beak appearance (very dilated oesophagus with smooth narrowing at its lower end) (barium meal) Oesophageal achlasia Cock screw (undulated) Diffuse appearance d/t teiary oesophageal contractions (barium meal) spasm Tiny flash shaped outpouchig Intramural arranged in clusters or longitudinal rows (on barium study). pseudodiveiculosis Shaggy (contour) appearance Candida with irregular plaque like filling Oesophagitis defects with intervening normal (double contrast mucosa (early), cobble stone or snake skin appearance or coalescent plaques (in late disease) which correspond to white plaques seen in endoscopy; Foamy oesophagus (tiny 1-3 mm bubble like lucencies producing foamy appearance). barium) Shelf like indentation from Cricopharyngeal/ anterior wall or well localized oesophageal web circumferential narrowing (at (when a/w Fe C5/C6) with minimal proximal dilatation and jet effect (on deficiency anemia, glossits & barium swallow) pharyngeal atrophy it is k/a Plummer Vinson Syndrome) Lucent, touous, worm like Esophageal varices filling defectss which disto the (dilated subepithelial mucosal pattern (on barium veins d/t increased swallow); thickened longitudinal collaterals). Uphill esophageal folds with fusiform varices (d/t poal seperation (on mucosal spot films); hypeension) are beaded or serpiginous confined to distal half longitudinal filling defects (best & down hill varices seen on mucosal relief views of (d/t SVC obstruction) collapsed oesophagus in prone RAO involve upper & position with high density barium middle pa of paste/suspension to increase oesophagus mucosal adherence). Endoscopy is * Extraluminal compression investigation of makes a shllow angle with wall of oesophagus. choice Smooth intramural filling defect Leiomyoma of with characteristic features of submucosal lesion i.e. smooth, rounded, semilunar indentation that makes a sharp angle with the wall of oesophagus with intact mucosa, splitting/narrowng the barium column, & widening the oesophageal diameter and splaying longitudinal esophageal folds. esophagus Annular apple core lesion with Carcinoma overhanging margins (or irregular stricture with Oesophagus Radiological features Disorders Beak sign; Double track or Tram track sign, Shoulder sign; String sign Hyperophic pyloric stenosis Seagull /Mercedez Benz/ Crow Feet Sign Radiolucent gall stone with gas Multiple gas fluid level (step ladder pattern) Intestinal obstruction Cigar bundle appearance on X-ray Winding highway railway tract on USG Medusa Head coloniesQ on CT scan Round worm Pincer sign, Claw appearance sign( 2, Coiled spring appearanceQ, Target sign, Meniscus sign (on barium enema) Intussception Shark mouth appearance Ileocecal valve Lead pipe appearanceQ Ulcerative colitis String of KantorQ, Bull's eye or Target lesion, Ram's horn stomach (narrow antrum, wide pylorus with flared up tubular antrum opening into corpus of stomach) Chron's disease (Regional ileitis) Thumb printing signQ Ischemic colitis (hallmarkQ) also in Amoebic & Ulcerative colitis Saw tooth appearanceQ (on barium enema) Diveicula of colon (Diveiculosis) Apple core lesion, Napkin's sign (on barium enema) Carcinoma colon Bilious vomiting in 1st month (hallmark), current jelly stools/ malena with double Midgut volvulus (torsion of gut bubble sign (x-ray); clockwise whirlpool sign (USG), apple-peel/twisted ribbon/Corckscrew & spiral appearance (barium study); whirl like pattern (CT); barber pole sign (angio) around SMA) Whirl sign (CT); bird of prey sign (tapered beak like distal aspect of twist on barium enema); white stripe sign & three line sign (respectively d/t obliquely oriented center line/ outerwall Sigmoid volvulus & center-line of U shaped loop), nohern exposure/bent tyre tube sign (greatly distended paralyzed loop with fluid-fluid level arising from pelvis & extending towards diaphragm), Coffee bean sign (midline crease corresponding to mesentry of largely gas distended loop)- on plain X-ray. Distension of small bowel & colon Necrotizing (loops wider than L1 veebral body +- enterocolitis air fluid level in right lower quadrant is (ischemic bowel (1st & most common sign), loss of mosaic disease of multifaceted bowel gaa pattern, large bowels may be impossible to differentiate from small bowel, fixed bowel or persistent loop sign, bowel wall thickening, thumb printingQ, pneumatosis intestinalisQ (black lines of intramural gas a/b white lines of intestinal wall), bubbly appearance of bowel wall, gas in poal venous system (plain horizontal beam cross table x-ray); zebra pattern; Y pattern & ring pattern (on USG) premature infants) shouldering) on barium Adynamic ileus pattern, nodular Pseudomembra? oesophagogram; other features haustral pattern (thumb printing - nous colitis may be irregular narrowed segment transverse banding = markedly (Clostridium of lumen, diffuse nodular filling thickened & distoed haustral folds difficile diseas) defects, irregular /smooth most prominent in transvere colon) -on tapering strictue, bulky plain x-ray; accordion sign (oral endophytic mass and fixed contrast traps between distoed varicoid appearance (i.e. b/o thickened closely spaced transvere submucosal spread of tumor, the edematous folds of low atenuation; is appearance may mimic that of varices, however, unlike varices it typical but seen only in severe cases), target sign and rarely pneumatosis coli is fixed & does not change in size +- poal vein gas - on CT; barium enema & shape at fluoroscopy) is contraindicated Bowler's hat sign, lace like/reticular surface pattern (characteristic of villous adenoma >> tubular adenoma) Colonic polyp
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