Oreo cookie sign in pericardial effusion

Pericardial effusion occurs when fluid builds up in the pericardium, the double-layered membrane that surrounds and protects the heart. This abnormal fluid buildup can be caused by infections, trauma, cancer, autoimmune diseases and other conditions.

The Oreo cookie sign describes a distinct pattern seen on medical imaging. On chest X-rays or more detailed scans, like a computed tomography (CT) scan (which uses special X-ray technology), the fluid in the pericardium forms the "cream" layer in the middle, with the outer layers of the “cookie” made up of the pericardial and epicardial membranes. Echocardiography, which uses sound waves to create real-time images of the heart, can also reveal this pattern.

The Oreo cookie sign is an important clue for diagnosing pericardial effusion, which can be serious. If the fluid buildup is large enough, it can lead to cardiac tamponade, a condition where the heart is compressed and cannot pump blood properly. Early detection and treatment are crucial to prevent complications.

Reference

Chiarenza A, Esposto Ultimo L, Falsaperla D, Travali M, Foti PV, Torrisi SE, Schisano M, Mauro LA, Sambataro G, Basile A, Vancheri C, Palmucci S. Chest imaging using signs, symbols, and naturalistic images: a practical guide for radiologists and non-radiologists. Insights Imaging. 2019;10(1):114. Go to reference

Oreo cookie sign, Oreo cookie

Image from Chiarenza A et al. Insights Imaging. 2019.

Fried egg appearance of Best disease

Best disease, or Best vitelliform macular dystrophy, is an inherited eye condition affecting the macula, the central region vital for clear vision. Typically appearing in childhood or adolescence and progressing over time, it results in central vision loss. Named after German ophthalmologist Dr. Friedrich Best, who observed a family with various stages of the disease in 1905. Best disease can reveal a distinctive fried egg appearance in the macula. This look, resembling a yellowish egg yolk, is caused by the buildup of lipofuscin, a fatty substance, in the retinal pigment epithelium cells. These cells support the retina, the light-sensitive layer of tissue in the eye. Imaging techniques, like fundoscopy, allow us to see this fried egg appearance.

Reference

Tripathy K, Salini B. Best Disease. [Updated 2023 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Go to reference

Fried egg appearance, Fried egg

Image from Nentwich MM, Rudolph G. Hereditary retinal eye diseases in childhood and youth affecting the central retina. Oman J Ophthalmol. 2013.

Candy cane aorta

The largest and main artery in the human body, the aorta, emerges from the heart. The aorta distributes oxygenated blood to all parts of the body. The aorta gives off various branches as it travels through the thorax and abdomen. The aorta's arch, which is curved and located in the thorax, joins the ascending and descending aortas. When examined from a side angle using X-rays or magnetic resonance imaging, the configuration of the ascending aorta, aortic arch and descending aorta resembles a candy cane or hockey stick in appearance – candy cane aorta.

In the abdomen, the aorta ends by splitting into the median sacral artery, a small midline vessel and the common iliac arteries, two major blood vessels. 

Reference:

Eikendal AL, Bots ML, Haaring C, Saam T, van der Geest RJ, Westenberg JJ, den Ruijter HM, Hoefer IE, Leiner T. Reference values for cardiac and aortic magnetic resonance imaging in healthy, young caucasian adults. PLoS One. 2016;11(10):e0164480. Go to reference.

Candy cane aorta, candy cane

Image from Eikendal AL et al. PLoS One. 2016.

   

Pear-shaped appearance of Babesia

Babesiosis is a rare disease caused by single-celled parasites which infect red blood cells. Babesia mainly infect animals with humans only being occasionally infected. These parasites are transmitted to humans primarily by tick bites. Their name originates from Victor Babeș (1854-1926), a Romanian physician who first described them.
Some infected people are asymptomatic. Certain groups of people are vulnerable to severe infection like those without a spleen and those with an impaired immune system. Under the microscope, these parasites are oval shaped within the red blood cells, a pear-shaped appearance.
Reference:

Zimmer AJ, Simonsen KA. Babesiosis. [Updated 2020 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Go to reference. 

Pear-shaped forms, pears

Image from Wikimedia Commons

Candy cane esophagus

Consuming very hot food and drink can injure the inside of the food pipe, the esophagus, which extends from the throat to the stomach. Normally the inside of the esophagus is pink. But when burnt by hot liquids or solids, alternating bands of red and white regions emerge, when examined by optical devices. These regions resemble candy cane in appearance – candy cane esophagus. Candy cane is a type of boiled sweet often found in alternating red and white stripes.

The outcome depends on the extent of esophageal thermal injury, with most reported cases having favorable outcomes.

Reference:

Lim CH, Yen H-H, Su W-W, Lim C-J, Tsai H-C, Chen S-T. Extensive Causative Esophagitis Caused by Thermal Injury: A Case Report and Review of the Literature. Case Reports in Gastrointestinal Medicine. 2017;2017:8243567. Go to reference

Candy cane esophagus, candy cane

Image from Lim. Case Reports in Gastrointestinal Medicine, 2017

Image from Wikimedia Commons