Trapped on the “whirl”: diagnostic sign on emergency CT

• Published in: Emergency radiology 2010-03, Vol.17 (2), p.139-147
• Main Authors: Suárez Vega, Víctor Manuel, Martí de Gracia, Milagros, Verón Sánchez, Ana, Alonso Gamarra, Eduardo, Garzón Moll, Gonzalo
• Format: Article
• Language: English
• Subjects: Databases, Factual; Diagnosis, Differential; Emergency Medicine; Hernia - diagnosis; Humans; Imaging; Intestinal Volvulus - diagnosis; Intestinal Volvulus - diagnostic imaging; Intestine, Small - diagnostic imaging; Medicine; Medicine & Public Health; Mesentery - diagnostic imaging; Pictorial Essay; Radiographic Image Interpretation, Computer-Assisted; Radiography, Abdominal; Radiology; Retrospective Studies; Tomography, X-Ray Computed
• ISSN: 1070-3004; 1438-1435
• DOI: 10.1007/s10140-009-0816-8

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.