Published in:
01-07-2016 | Classics in Abdominal Imaging
The String of Pearls Sign
Published in: Abdominal Radiology | Issue 7/2016
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Often referred to as the “Queen of Gems”, pearls have been revered spanning both time and culture [1] (Fig. 1). The String of Pearls Sign metaphorically describes a radiographic finding highly suggestive of mechanical small bowel obstruction. As small bowel becomes distended intraluminal fluid traps gas along the valvulae conniventes. Upright radiographs depict a row of elliptical lucencies produced by the meniscal surface of fluid on one side and the bowel wall on the other, evocative of a string of pearls [2‐4] (Fig. 2A). The imaging sign can also be observed at computed tomography [5] (Fig. 2B).
Fig. 1
The Pearl Necklace by Dod Procter circa 1932–1941, reproduced with permission from the Royal Academy of Arts [6]
Fig. 2
The String of Pearls Sign in a patient with mechanical small bowel obstruction due to adhesions. A Upright frontal radiograph and B sagittal reformatted image from a contrast enhanced computed tomography of the abdomen and pelvis demonstrating pockets of air trapped along the valvulae conniventes (arrows)
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