Cobra head sign (ureter)

Last revised by Mohammad Taghi Niknejad on 13 Mar 2024

The cobra head sign, also known as the spring onion sign, refers to dilatation of the distal ureter, surrounded by a thin lucent line seen in patients with an adult-type ureterocele. The cobra head appearance indicates an uncomplicated ureterocele.

During an excretory phase of an intravenous urography, the lucent "hood" of the cobra represents the combined thickness of the ureteral wall and prolapsed bladder mucosa, outlined by contrast material within the bladder lumen.

This lucent line should be thin and well defined. Any thickening, irregularity, or loss of definition of the cobra’s hood should raise concern for the presence of a pseudoureterocele.

Radiologic visualization can be established using radiographic urography, magnetic resonance urography, computed tomography urography or prenatal ultrasonography regarding fetal patients 3.

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