Mistletoe sign

Changed by Ferenc Imre Suhai, 21 Dec 2020

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The mistletoe sign refers to solid enhancing perivascular masses around the coronary arteries in the presence of idiopathic retroperitoneal fibrosis (Ormond's disease).The presence of the mistletoe sign on cardiac MR and coronary CT angiographic images is probably rare, but it might be a characteristic manifestation of retroperitoneal fibrosis. With the increasing number of noninvasive cardiac imaging tests performed worldwide, the recognition of the mistletoe sign could be helpful in diagnosing retroperitoneal fibrosis.

A similar appearance can also occur incoronary vasculitis, IgG4 for related autoimmune disease and systemic vasculitides (Takayasu disease, Kawasaki disease, and Behçet disease).

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3. Maurovich-Horvat P, Suhai FI, Czimbalmos C, et al. Coronary Artery Manifestation of Ormond Disease: The "Mistletoe Sign". (2017) Radiology. 282 (2): 356-360. <a href="https://doi.org/10.1148/radiol.2016160644">doi:10.1148/radiol.2016160644</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27548369">Pubmed</a>
2. Sakamoto A, Tanaka T, Hirano K, et al. Immunoglobulin G4-related Coronary Periarteritis and Luminal Stenosis in a Patient with a History of Autoimmune Pancreatitis. (2017) Internal medicine (Tokyo, Japan). 56 (18): 2445-2450. <a href="https://doi.org/10.2169/internalmedicine.8259-16">doi:10.2169/internalmedicine.8259-16</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28824056">Pubmed</a>
1. Matsumoto Y, Kasashima S, Kawashima A, et al. A case of multiple immunoglobulin G4-related periarteritis: a tumorous lesion of the coronary artery and abdominal aortic aneurysm. (2008) Human pathology. 39 (6): 975-80. <a href="https://doi.org/10.1016/j.humpath.2007.10.023">doi:10.1016/j.humpath.2007.10.023</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18430457">Pubmed</a>

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