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Citation:
Bell D, Shah V, Exclamation mark sign (limy bile). Reference article, Radiopaedia.org (Accessed on 24 Apr 2024) https://doi.org/10.53347/rID-74913
The exclamation mark sign is a pathognomonic imaging sign of the rare diagnosis of limy bile on plain abdominal radiography. It occurs when there is both limy bile and a gallstone in the common bile duct. The linear vertical radiopaque bile forms the line of the exclamation mark (i.e. !), whilst a more distal calculus forms the 'dot' at the end of the exclamation mark 1.
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1. Koca YS, Koca T, Barut I. Limy bile syndrome complicated with primary hyperparathyroidism. (2015) Case reports in surgery. 2015: 928217. doi:10.1155/2015/928217 - Pubmed
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