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Manta ray sign (bladder)

Last revised by Dr Ian Bickle on 09 Mar 2020

The manta ray sign is a radiographic appearance in bladder exstrophy. It describes wide midline separation of the pubic bones simulating the appearance of a manta ray swimming towards you 1. The sacrum and iliac wings recall the manta ray’s head and body, with the widely spaced pubic rami forming its cephalic flaps .

Differential diagnosis

On a plain radiograph consider:

  • open book pelvic injuries: the smooth arc of the pelvis outline in bladder exstrophy differentiates it from acquired separation of the pubic symphysis seen in open book pelvic injuries

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Cases and figures

  • Figure 1: a manta ray
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  • Case 1: manta ray sign
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  • Case 2
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  • Case 3
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  • Case 4
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  • Case 5
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