ª Springer Science+Business Media New York 2014

Abdominal Imaging

Abdom Imaging (2014) DOI: 10.1007/s00261-014-0241-7

The hamburger sign (sandwich sign) Amanda M. Romesberg,1 James T. Lee,2 David J. DiSantis2 1

Kentucky College of Osteopathic Medicine, Pikeville, KY, USA Department of Radiology, Chandler Medical Center, University of Kentucky, HX-315B, 800 Rose Street, Lexington, KY 40536, USA 2

Since its debut at the 1904 World’s Fair in St. Louis [1], the hamburger (Fig. 1A) has become a defining symbol of American fast food culture. The hamburger (or sandwich) sign was first described in 1976 as a sonographic finding specific for mesenteric lymphoma [2]; a similar appearance can be found on computed tomography (Fig. 1B) and magnetic resonance imaging as well [3–5].

Confluent mesenteric adenopathy surrounding the mesenteric vessels is reminiscent of a beef patty (mesenteric vasculature and fat) sandwiched in a bun (the adenopathy) (Fig. 1B) [6]. This finding typically indicates lymphoma, most commonly non-Hodgkin [4–6]. In the appropriate clinical setting, post-transplant lymphoproliferative disease would be an additional differential diagnostic consideration [5].

Fig. 1. A (left) First author’s hamburger. B (right) The hamburger sign in a patient with lymphoma. Contrast enhanced CT depicts mesenteric vessels and fat [the ‘‘patty’’ (black arrows)] enveloped by bulky mesenteric adenopathy [the ‘‘bun’’ (white arrows)].

Correspondence to: James T. Lee; email: [email protected]

A. M. Romesberg et al.: The hamburger (sandwich) sign

References 1. Cartwright G (2014) The world’s first hamburger. Texas Monthly. http://www.texasmonthly.com/story/world%E2%80%99s-first-hambur ger. Accessed on 22 Aug 2014. 2. Kobayashi T, Takatani O, Kimura K (1976) Echographic patterns of malignant lymphoma. J Clin Ultrasound 4(3):181–186 3. Johnson CD (2014) ‘‘Fluid and masses of the peritoneum and mesentery’’: lymphoma—the hamburger sign. In: Johnson CD (ed)

Mayo Clinic gastrointestinal imaging review, 2nd edn. New York: Oxford University Press, p 822 4. Gaillard F et al (2014) Sandwich sign. http://radiopaedia.org/ articles/sandwich-sign-1. Accessed on 22 Aug 2014 5. Hardy SM (2003) Signs in imaging: the sandwich sign. Radiology 226(3):651–652 6. Mueller PR, Ferucci JT (1980) Appearance of lymphomatous involvement of the mesentery by ultrasonography and body computed tomography: the ‘‘sandwich sign’’. Radiology 134:467–473

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