Hellmer sign

Last revised by Daniel J Bell on 12 Oct 2020

Hellmer sign is a radiographic finding depicting medial displacement of the lateral edge of the liver from the peritoneal wall. It was originally described as a pathognomonic sign of ascites. However, this displacement can also be caused by intraperitoneal fat, extraperitoneal free fluid or a mass 2.

The presence of Hellmer sign on a plain abdominal radiograph should be confirmed with ultrasound and if required cross-sectional imaging can be done to further investigate the cause of the liver displacement 2.

The reported accuracy of Hellmer sign is very broad, sensitivity 4-50% and specificity up to 100%. The broad range of sensitivities has been put down to the cohorts in some studies being predominantly made up of patients with large volumes of fluid (>2000 mL) 5-7

Low kVP technique, good collimation, and right posterior oblique positioning are supposed to improve visualization of this sign 2.

History and etymology

The sign is named after Hans Hellmer (1898-1949) 8, a Swedish Professor of radiology at the University of Lund, who originally published about the sign in 1942. Unfortunately like many radiologists of his generation he suffered x-ray-mediated injuries to both hands necessitating multiple finger amputations 3,4

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