ª Springer Science+Business Media New York 2014
Abdominal Imaging
Abdom Imaging (2014) DOI: 10.1007/s00261-014-0273-z
The goblet sign Whitney J. Morgan, Raymond B. Dyer Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA
Abstract The purpose of this article is to describe the imaging appearance of the ‘‘goblet sign’’ and review the clinical significance of this sign.
Discussion The ‘‘goblet sign’’ (Fig. 1) describes the distinctive imaging appearance of a ureter in the presence of a slow growing intraluminal ureteral mass [1, 2]. As the mass progressively grows and expands the ureteral lumen, the resulting focally dilated ureter distal to the mass takes on a cup-shaped appearance when opacified with contrast material (Fig. 2). The expanded ureteral wall corresponds to the sides of the goblet, whereas the inferior contour of the mass corresponds to the rim (Figs. 2, 3). Originally described on retrograde ureteropyelography, the goblet sign can also be seen on other imaging modalities, including excretory urography and CT and MR urography (Fig. 3). Although classically attributed to the presence of an intraluminal transitional cell carcinoma, less common etiologies include metastatic disease, endometriosis, or any slow growing lesion that has predominately intraluminal growth within the ureter [1]. In the setting of an acute obstruction, such as with ureterolithiasis, the ureter is unable to accommodate the
Correspondence to: Whitney J. Morgan; email: wmorgan@wakehealth. edu
Fig. 1.
A goblet (photo courtesy of Philippe Tirman).
W. J. Morgan, R. B. Dyer: The goblet sign
Fig. 2. Retrograde ureteropyelography—single front view after retrograde injection of contrast material, opacifying the ureter distal to a large intraluminal mass (asterisk), producing the goblet sign.
Fig. 3. MR urogram–coronal image (T2 weighted sequence with fat saturation) with an intraluminal ureteral mass and mild downstream dilatation producing the goblet sign (arrow). Surgical pathology revealed a low grade papillary urothelial carcinoma. Multiple bilateral renal cysts are incidentally seen (asterisk).
W. J. Morgan, R. B. Dyer: The goblet sign
obstructing process. Focal downstream ureteral dilatation does not occur, therefore a goblet sign will be absent (Fig. 4) [3]. In fact, the distal ureter is often narrowed with an acute obstructive process due to reactive edema and ureteral spasm [4]. The proximal ureter can be dilated to a variable degree in both the acute and chronic setting, depending on the extent of obstruction, therefore is not a helpful discriminator of chronicity. References 1. Dyer RB, Chen MY, Zagoria RJ (2004) Classic signs in uroradiology. RadioGraphics 24:S247–S280 2. Browne RFJ, Meehan CP, Colville J, Power R, Torreggiani WC (2005) Transitional cell carcinoma of the upper urinary tract: spectrum of imaging findings. RadioGraphics 25:1609–1627 3. Kawashima A, Goldman SM (2000) Neoplasms of the renal collecting system, pelvis, and ureters. In: Pollack HM, McClennan BL (eds) Clinical urography, 2nd edn. Philadelphia: Saunders, pp p1560– p1641 4. Daniels RE (1999) The goblet sign. Radiology 210:737–738
Fig. 4. Retrograde ureteropyelography—acute partial obstruction of the left ureter secondary to a urinary calculus (arrow). There is no dilatation of the distal ureter, therefore the goblet sign is absent.
Abdominal Imaging
Abdom Imaging (2014) DOI: 10.1007/s00261-014-0273-z
The goblet sign Whitney J. Morgan, Raymond B. Dyer Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157, USA
Abstract The purpose of this article is to describe the imaging appearance of the ‘‘goblet sign’’ and review the clinical significance of this sign.
Discussion The ‘‘goblet sign’’ (Fig. 1) describes the distinctive imaging appearance of a ureter in the presence of a slow growing intraluminal ureteral mass [1, 2]. As the mass progressively grows and expands the ureteral lumen, the resulting focally dilated ureter distal to the mass takes on a cup-shaped appearance when opacified with contrast material (Fig. 2). The expanded ureteral wall corresponds to the sides of the goblet, whereas the inferior contour of the mass corresponds to the rim (Figs. 2, 3). Originally described on retrograde ureteropyelography, the goblet sign can also be seen on other imaging modalities, including excretory urography and CT and MR urography (Fig. 3). Although classically attributed to the presence of an intraluminal transitional cell carcinoma, less common etiologies include metastatic disease, endometriosis, or any slow growing lesion that has predominately intraluminal growth within the ureter [1]. In the setting of an acute obstruction, such as with ureterolithiasis, the ureter is unable to accommodate the
Correspondence to: Whitney J. Morgan; email: wmorgan@wakehealth. edu
Fig. 1.
A goblet (photo courtesy of Philippe Tirman).
W. J. Morgan, R. B. Dyer: The goblet sign
Fig. 2. Retrograde ureteropyelography—single front view after retrograde injection of contrast material, opacifying the ureter distal to a large intraluminal mass (asterisk), producing the goblet sign.
Fig. 3. MR urogram–coronal image (T2 weighted sequence with fat saturation) with an intraluminal ureteral mass and mild downstream dilatation producing the goblet sign (arrow). Surgical pathology revealed a low grade papillary urothelial carcinoma. Multiple bilateral renal cysts are incidentally seen (asterisk).
W. J. Morgan, R. B. Dyer: The goblet sign
obstructing process. Focal downstream ureteral dilatation does not occur, therefore a goblet sign will be absent (Fig. 4) [3]. In fact, the distal ureter is often narrowed with an acute obstructive process due to reactive edema and ureteral spasm [4]. The proximal ureter can be dilated to a variable degree in both the acute and chronic setting, depending on the extent of obstruction, therefore is not a helpful discriminator of chronicity. References 1. Dyer RB, Chen MY, Zagoria RJ (2004) Classic signs in uroradiology. RadioGraphics 24:S247–S280 2. Browne RFJ, Meehan CP, Colville J, Power R, Torreggiani WC (2005) Transitional cell carcinoma of the upper urinary tract: spectrum of imaging findings. RadioGraphics 25:1609–1627 3. Kawashima A, Goldman SM (2000) Neoplasms of the renal collecting system, pelvis, and ureters. In: Pollack HM, McClennan BL (eds) Clinical urography, 2nd edn. Philadelphia: Saunders, pp p1560– p1641 4. Daniels RE (1999) The goblet sign. Radiology 210:737–738
Fig. 4. Retrograde ureteropyelography—acute partial obstruction of the left ureter secondary to a urinary calculus (arrow). There is no dilatation of the distal ureter, therefore the goblet sign is absent.
