Important Signs in Surgery
This is a collection of a large number of important clinical and radiological signs in surgery. Most of these are eponyms. Comment to add more signs to this list.
Basilar skull fracture:
- Racoon/Panda sign: Periorbital ecchymoses
- Battle’s sign: Retroauricular (Over mastoid process) ecchymoses
- Seat-belt sign: Ecchymotic area found in the distribution of the lower anterior abdominal wall and can be associated with perforation of the bladder or bowel as well as a lumbar distraction fracture (Chance fracture).
- Cullen’s sign: Periumbilical ecchymosis which is indicative of intraperitoneal hemorrhage.
- Grey–Turner’s sign: Flank ecchymoses which is indicative of retroperitoneal hemorrhage.
- Kehr’s sign: Left shoulder or neck pain secondary to splenic rupture. It increases when patient is in Trendelenburg position or with left upper quadrant (LUQ) palpation (caused by diaphragmatic irritation).
- Danforth’s sign: Shoulder pain on inspiration due to hemoperitoneum
- Balance’s sign: Fixed dullness in the left flank with shifting dullness best appreciated in the right flank, resulting from intraperitoneal and extraperitoneal bleeding following splenic rupture.
- Coopernail’s sign: Ecchymosis of the perineum and scrotum or labia due to pelvic fracture
- Destot’s sign: Scrotal hematoma suggesting pelvic fracture
- Marie’s sign: Fine tremor in hyperthyroidism
- Maroni sign: Erythema of the skin overlying thyroid
- Pemberton’s sign: Symptoms of faintness with evidence of facial congestion and external jugular venous obstruction when the arms are raised above the head (a maneuver that draws the thyroid into the thoracic inlet).
- Berry’s sign: Absence of carotid pulsation from tumor encasing carotid sheath
Eye signs of Primary thyrotoxicosis:
- Dalrymple’s sign: Upper sclera is visible due to retraction of upper eyelid
- Joffroy’s sign: Absence of wrinkling of the forehead when the patient looks upwards with the face inclined downwards
- Von Graefe’s sign: The upper eyelid lags behind the eyeball as the patient is asked to look downwards
- Boston sign: Jerking of the lagging lid
- Griffith’s sign: Lag of the lower lids during elevation of the globe
- Stellwag’s sign: Staring look and infrequent blinking of eyes with widening of palpebral fissure
- Moebius sign: Inability or failure to converge the eyeballs
- Riesman’s sign: Bruit over the closed eyes
- Rosenbach’s sign: Tremor of the closed eyelids
Archibald’s sign (Pseudohypoparathyroidism of Albright’s hereditary osteodystrophy): Characeristic shortening of the 4th and 5th digits as dimpling over the knuckles of a clenched fist
Signs of hypocalcemia:
- Chvostek’s sign: Tapping over the facial nerve in front of the tragus of the ear causes ipsilateral twitching
- Trousseau’s sign: Carpopedal spasm following inflation of sphygmomanometer cuff to above systolic BP for several minutes
Deep vein thrombosis (DVT):
- Homan’s sign: Calf pain on dorsiflexion of the foot
- Mose’s or Bancroft’s sign: Calf tenderness on squeezing the calf muscles from side to side
- Lisker’s sign: Tenderness to percussion of the medial anterior tibial surface
- Louvel’s sign: Venous pain induced by coughing, prevented by pressing over proximal end of vein
- Lowenberg’s sign: Two calves are wrapped with cuffs to see if there is assymetry in tolerance to pressure of 180 mmHg
- Pratt’s sign: Presence of 3 dilated veins or sentinel veins over the tibia which persists when legs are elevated to 45 degrees
- Ramirez sign: Sphygmomanometer cuff placed above knee inflated to 40mmHg causing pain at the site of thrombosis
- Crueveilhier’s sign (saphena varix): Cough impulse felt at the saphenofemoral junction in standing position.
Peripheral Vascular Disease:
- Adson’s sign: In thoracic outlet syndrome, decrease in ipsilateral radial pulse and/or presence of subclavian bruit while patient extending neck maximally, rotating head towards side being tested, and holding breath.
- Buerger’s sign: Red foot becomes pale after elevation
- Henle-Coenen sign: If an arteriovenous fistula is occluded and the distal vessels still pulsate, this indicates that the fistula can be safely treated by ligation.
- Branham’s sign: Bradycardia after compression of AV fistula
- Corrigan’s sign: Visible neck pulsation
- De Musset’s sign: Bobbing of head with heartbeat
- Duroziez sign: Presence of diastolic femoral bruit when femoral artery is compressed enough to hear a systolic bruit
- Hill’s sign: Systolic pressure in the legs > 20 mm Hg higher than in the arms
- Quincke’s sign: Nail bed pulsation
- Pointing sign: Patient precisely localise the pain where it started and where to moved.
- Rovsing’s sign: Pain in RLQ when palpation pressure is exerted in LLQ
- Dunphy’s sign: Increased pain with coughing
- Aaron sign: Pain or pressure in epigastrium or anterior chest with persistent firm pressure applied to McBurney’s point
- Ten Horn sign: Pain caused by gentle traction of right testicle
- Cope’s psoas sign (Retrocecal appendicitis): Pelvic pain upon extension of the right thigh
- Cope’s obturator sign (Pelvic appendicitis): Pelvic pain upon internal rotation of the right thigh
- Bassler sign (Chronic appendicitis): Sharp pain created by compressing appendix between abdominal wall and iliacus
- Adler sign: For distinguishing appendicitis from adnexal or uterine pain, if the point of maximal tenderness shifts medially with repositioning on the left lateral side, etiology is generally gynecologic.
- Guarding: Voluntary contraction of abdominal muscles in response to palpation due to mild parietal peritoneum irritation
- Rigidity: Involuntary contraction of abdominal muscles due to marked parietal peritoneum irritation
- Blumberg’s sign: Transient abdominal wall rebound tenderness
- Tanyol’s sign: umbilicus is displaced upwards by swelling arising from pelvis or downwards by ascites.
- Beevor’s sign: lesions of T9-T10 paralyze lower but spare upper abdominal muscles, resulting in upward movement of umbilicus when abdominal wall contracts
- Murphy’s sign: laying the hand lightly on the upper right abdomen and asking the patient to take a deep breath cause a catch in breath because of pain when the inflamed gall bladder impacts on the examining hand.
- Boa’s sign: Hyperaesthesia of skin over the right ribs 9-11 posteriorly
Ruptured Common Bile duct:
- Ranshoff sign: Yellow discoloration of umbilical region
- Kenaway’s sign: A venous hum that is louder on inspiration (on auscultation with the bell of the stethoscope below the xiphisternum), associated with splenomegaly.
Guy-Mallet sign: Turn patient to right with hips & knees flexed. Tenderness is present on deep palpation of Left subcostal & epigastric regions.
- Sentinel-loop sign: dilated proximal jejunal loop adjacent to pancreas because of local ileus
- Colon cut-off sign: isolated distention of the transverse colon with no air distally
- “Renal halo” sign: Extension of edematous fluid into the anterior perirenal space may create a mass effect and a halo sign with sparing of the perinephric fat
Acute hemorrhagic pancreatitis:
- Cullen’s sign
- Grey-turner’s sign
- Fox’s sign: Bruising over inguinal ligament
- Reversed ‘3’ sign (Barium meal): widening of the duodenal loop with medial filling defect
- Courvoisier’s sign: A palpable, non-tender gallbladder in a jaundiced patient indicates periampullary tumor (including carcinoma of head of pancreas).
- Bird’s beak sign (Barium swallow): Tapering of the distal esophagus leading to collection of contrast material in the proximal dilated segment and the passage of a small amount of contrast through the narrowed LES.
- Rat tail sign (Barium swallow): Long stenotic segment
- Kalokerino’s sign: A filling defect of the fundus of the stomach that mimics a neoplasm. It arises when part of the fundus to the left of the cardio-oesophageal junction is about to herniate through it.
- String sign: from elongated pyloric channel
- Shoulder sign: bulge of pyloric muscle into the antrum
- Double tract sign: parallel streaks of barium in the narrow channel
- Cushion sign: On endoscopy, a gastric lipoma will feel like a cushion or pillow when pressed with the forceps.
- Troisier’s sign: Enlargement of the left supraclavicular lymph node due to advanced metastatic gastric (and other intra-abdominal) carcinoma.
- Trousseau’s sign: Migratory thrombophlebitis associated with gastric (and other intra-abdominal) carcinoma.
Malrotation or Midgut Volvulus and Duodenal atresia:
- Double bubble sign (AXR): air in stomach and duodenum
- Bird beak sign
- Coffee bean sign
- Dance’s sign: RUQ mass due to absence of bowel in RLQ
- Target sign (AXR): two concentric circles of fat density
- Target or donut sign (USG): single hypoechoic ring with hyperechoic center
- Pseudokidney sign (USG): superimposed hypoechoic (edematous walls of bowel) and hyperechoic (areas of compressed mucosa) layers
Inflammatory Bowel Disease (IBD):
- Kantor’s String sign (Barium enema): Thread-like structure of terminal ileum due to luminal narrowing due to long areas of circumferential inflammation and fibrosis, in Chron’s Disease.
- Lead pipe appearance (Barium enema): Loss of haustrations in Ulcerative colitis
- Klein’s sign: Right iliac fossa pain that moves to the left when the patient turns on to his left side. It can be associated with mesenteric lymphadenitis and Meckel’s diverticulum.
STRANGULATED OBTURATOR HERNIA
- Howship-Romberg sign: Pain referred to the inner aspect of the knee via the genicular branch of the obturator nerve, which may arise from an obturator hernia that strangulates.
- Hannington-Kiff sign: Ipsilateral loss of the adductor reflex with preservation of patellar reflex
- Prehn’s sign (Epididymo-orchitistis): Relief of pain by elevation of the testicle
- Vermooten’s sign (Rupture of prostatic urethra): Digital rectal examination reveals a doughy, displaced, or absent prostate in the presence of an intrapelvic rupture of the prostatic urethra.
- Blue-dot sign: Torsion of testicular appendages
- Silk glove sign: Indirect hernia sac in pediatric patient
- Stemmer sign(lymphoedema): The clinician can not pinch a fold of skin on the dorsum of the second toe and is due the skin becoming inelastic.
- Hutchinson’s sign (Melanoma): Pigment in the paronychial area
- Kelly’s sign: Visible peristalsis of ureter in response to squeezing or retraction during surgery
- Drooping lily sign (Neuroblastoma): Inferior displacement of opacified calyces observed in intravenous pyelography
- Boomerang sign (Hydrocephalus): In a young person ≤ 35 to 40 years of age, appearance of the temporal tips of the lateral ventricles is one of the earliest manifestations of hydrocephalus
- Blueberry muffin sign: Subcutaneous blue nodules in neuroblastoma
- Macewen’s sign (Hydrocephalus): Tapping on the head of a hydrocephalic infant produces a cracked pot sound.
- Froment’s sign (Ulnar nerve palsy): Weakness of the adductor pollicis following a high ulnar nerve palsy leads to compensatory overaction of the flexor pollicis longus (innervated by the median nerve) when the patient is asked to squeeze a sheet of paper between thumb and index finger.
- Kanavel’s sign: Is due to an infected ulnar bursa. Greatest tenderness is elicited in the transverse palmar crease on the ulnar side.
- Tinel’s sign: Transient finger paraesthesia that follows percussion of the median nerve proximal to the wrist in patients with median nerve compression due to carpal tunnel syndrome.
- Von Rosen’s sign: Congenital dislocation of the hip; results in a click when the hip is flexed and adducted, then flexed and abducted, as this causes the femoral head to dislocate and relocate.
- Hamman’s sign: Subcutaneous emphysema over neck and chest wall (Primary spontaneous pneumomediastinum)
- Carnett’s sign: Loss of abdominal tenderness when abdominal wall muscles are contracted (Intra-abdominal source of abdominal pain)
- Chandelier sign: Extreme lower abdominal and pelvic pain with movement of cervix (Pelvic inflammatory disease)
- Fothergill’s sign: Abdominal wall mass that does not cross midline and remains palpable when rectus contracted (Rectus sheath hematoma)
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