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Twinkling sign
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Author(s) :
Ravi Kadasne, MD
 
Presentation A young man presents with a history of known vesical calculus. An ultrasound was performed.
 
 
 
Caption: Transabdominal scan of the urinary bladder
Description: A small echogenic focus is seen in the urinary bladder, which shows posterior acoustic shadowing. This is consistent with vesical calculus.
 
 
 
Caption: Color Doppler image of the vesical calculus
Description: Posterior to the echogenic calculus, an array of color flow is seen. This is known as the ‘twinkling sign’.
 
Differential Diagnosis Twinkling sign
 
Final Diagnosis Twinkling sign
 
Discussion Chelfouh, et al in their article have described the ‘twinkling artifact’ as a color-flow sonographic artifact seen behind calcifications and presenting as a random color encoding in the region where shadowing would be expected on gray-scale images. The twinkling sign has been described to be seen with urinary and biliary calculi and also encrustrated indwelling ureteral stents.
 
Case References 1. Chelfouh N, Grenier N, Higueret D, Trillaud H, Levantal O, Pariente JL, Ballanger P. Characterization of urinary calculi: in vitro study of "twinkling artifact" revealed by color-flow sonography. AJR Am J Roentgenol. 1998 Oct; 171(4):1055-60.
2. Conkbayir I, Yanik B, Senyucel C, Hekimoglu B. Twinkling artifact in color Doppler ultrasonography: pictorial essay. Tani Girisim Radyol. 2003 Dec; 9(4):407-10.
3. Aytac SK, Ozcan H. Effect of color Doppler system on the twinkling sign associated with urinary tract calculi. J Clin Ultrasound. 1999 Oct; 27(8):433-9.
 
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