Citation, DOI, disclosures and article data
Citation:
Lim C, Bell D, Moore C, et al. Hellmer sign. Reference article, Radiopaedia.org (Accessed on 30 Mar 2025) https://doi.org/10.53347/rID-76972
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.
-
1.Sarah J. Menashe, Ramesh S. Iyer, Marguerite T. Parisi, Randolph K. Otto, Edward Weinberger, A. Luana Stanescu. Pediatric Abdominal Radiographs: Common and Less Common Errors. (2017) American Journal of Roentgenology. 209 (2): 417-429. doi:10.2214/AJR.17.17889 - Pubmed
-
2.Priya Pathak, Raymond B. Dyer. Hellmer’s sign. (2018) Abdominal Radiology. 43 (12): 3523. doi:10.1007/s00261-018-1635-8 - Pubmed
-
3. D Wixson, E Kazam, JP Whalen. Displaced lateral surface of the liver (Hellmer's sign) secondary to an extraperitoneal fluid collection. (2012) American Journal of Roentgenology. 127 (4): 679-82. doi:10.2214/ajr.127.4.679 - Pubmed
-
4. Hellmer H : Die Konturen des rechten Leberlappens beim
Ascites. Acta RadioI 23: 533-540, 1942
-
5. Love L, Demos TC, Reynes CJ, Williams V, Shkolnik A, Gandhi V, Zerofos N. Visualization of the lateral edge of the liver in ascites. (1977) Radiology. 122 (3): 619-22. doi:10.1148/122.3.619 - Pubmed
-
6. Bundrick TJ, Cho SR, Brewer WH, Beachley MC. Ascites: comparison of plain film radiographs with ultrasonograms. (1984) Radiology. 152 (2): 503-6. doi:10.1148/radiology.152.2.6739823 - Pubmed
-
7. Proto AV, Lane EJ. Visualization of differences in soft-tissue densities. The liver in ascites. (1976) Radiology. 121 (1): 19-23. doi:10.1148/121.1.19 - Pubmed
-
8. Hans H. In Memoriam. Acta Radiologica. 1949;os-31(5-6):371-375. doi:10.1177/02841851490310050
Promoted articles (advertising)
Unable to process the form. Check for errors and try again.