Hellmer sign

Last revised by Daniel J Bell on 12 Oct 2020

Citation, DOI, disclosures and article data

Citation:

Lim C, Bell D, Moore C, et al. Hellmer sign. Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-76972

DOI:

https://doi.org/10.53347/rID-76972

Permalink:

https://radiopaedia.org/articles/76972

rID:

76972

Article created:

2 May 2020, CK Lim

Disclosures:

At the time the article was created CK Lim had no recorded disclosures.

View CK Lim's current disclosures

Last revised:

12 Oct 2020, Daniel J Bell ◉

Disclosures:

At the time the article was last revised Daniel J Bell had no recorded disclosures.

View Daniel J Bell's current disclosures

Revisions:

6 times, by 4 contributors - see full revision history and disclosures

Systems:

Gastrointestinal

Sections:

Signs

Synonyms:

Hellmer's sign
Medial displacement of the lateral liver edge sign

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.