Abstract
The “whirl sign” is an uncommon finding on emergency CT. However, it is easy to overlook if not kept in mind. Its recognition is of capital importance, being most of its causes potentially lethal. Surgical treatment is also mandatory when signs of complication are found. The whirl sign is usually found associated to midgut, cecal and sigmoid volvulus, small-bowel volvulus and closed-loop obstructions, and post-surgical mesenteric windows (including retroanastomotic hernias). CT is an optimal imaging technique to depict the so-called sign and associated CT features suggesting complication (circumferential wall thickening, pneumatosis intestinalis, pneumoperitoneum, mesenteric fat stranding, free intraperitoneal fluid, mesenteric haziness). Radiologists must be able to recognize the whirl sign and seek associated findings that strongly support the diagnosis of a spectrum of entities, some of them lethal if no treatment is established.
Similar content being viewed by others
References
Fisher JK (1981) Computed tomographic diagnosis of volvulus in intestinal malrotation. Radiology 140:145–146
Shimanuki Y, Aihara T, Takano H et al (1996) Clockwise whirlpool sign at color Doppler US: an objective and definite sign of midgut volvulus. Radiology 199:261–264
Berrocal T, Lamas M, Gutiérrez J et al (1999) Congenital anomalies of the small intestine, colon, and rectum. Radiographics 19:1219–1236
Aidlen J, Anupindi SA, Jaramillo D, Doody DP (2005) Malrotation with midgut volvulus: CT findings of bowel infarction. Pediatr Radiol 35:529–531. doi:10.1007/s00247-004-1355-9
Loh YH, Dunn GD (2000) Computed tomography features of small bowel volvulus. Australas Radiol 44:464–467. doi:10.1046/j.1440-1673.2000.00856.x
Balthazar EJ, Birnbaum BA, Megibow AJ et al (1992) Closed-loop and strangulating intestinal obstruction: CT signs. Radiology 185:769
Delabrousse E, Sarliève P, Sailley N, Aubry S, Kastler BA (2007) Cecal volvulus: CT findings and correlation with pathophysiology. Emerg Radiol 14:411–415. doi:10.1007/s10140-007-0647-4
Kwon JH, Jang HY (2005) Retroanastomotic hernia after gastrojejunostomy: US and CT findings with an emphasis on the whirl sign. Abdom Imaging 30:656–664. doi:10.1007/s00261-005-0310-z
Blake MP, Mendelson RM (1996) The whirl sign: a non-specific finding of mesenteric rotation. Australas Radiol 40:136–139. doi:10.1111/j.1440-1673.1996.tb00367.x
Gollub MJ, Yoon S, Smith LM, Moskowitz CS (2006) Does the CT whirl sign really predict small bowel volvulus? Experience in an oncologic population. J Comput Assist Tomogr 30:25–32. doi:10.1097/01.rct.0000191680.28344.f0
Nichols DM, Li DK (1983) Superior mesenteric vein rotation: a CT sign of midgut malrotation. AJR Am J Roentgenol 141:707–708
Clark P, Ruess L (2005) Counterclockwise barber-pole sign on CT: SMA/SMV variance without midgut malrotation. Pediatr Radiol 35:1125–1127. doi:10.1007/s00247-005-1517-4
Epelman M (2006) The Whirlpool sign. Radiology 240:910–911. doi:10.1148/radiol.2403040370
Long FR, Kramer SS (1996) Radiographic patterns of intestinal malrotation in children. Radiographics 16:547–556
Juler GL, Stemmer EA, Connoly JE (1971) Preoperative diagnosis of small bowel volvulus in adults. Am J Gastroenterol 56:235–247
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Suárez Vega, V.M., Martí de Gracia, M., Verón Sánchez, A. et al. Trapped on the “whirl”: diagnostic sign on emergency CT. Emerg Radiol 17, 139–147 (2010). https://doi.org/10.1007/s10140-009-0816-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10140-009-0816-8