Citation, DOI & article data
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 MRI and coronary CT angiography is relatively rare, but it might be a characteristic manifestation of retroperitoneal fibrosis. With the increasing number of non-invasive cardiac imaging tests performed worldwide, the recognition of this imaging sign could aid the diagnosis of retroperitoneal fibrosis.
History and etymology
The sign was first described by Pál Maurovich-Horvat and colleagues in 2017 3.
The appearance of the soft tissue around the coronary arteries invokes the appearance of mistletoe, a hemiparasitic plant, around the branches of a tree that it has invaded (see Figure 1).
Similar appearances with:
- 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. doi:10.1016/j.humpath.2007.10.023 - Pubmed
- 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. doi:10.2169/internalmedicine.8259-16 - Pubmed
- 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. doi:10.1148/radiol.2016160644 - Pubmed
- 4. Xu X, Bai W, Ma H, et al. Remission of "mistletoe sign" after treatment. (2020) Journal of cardiovascular computed tomography. 14 (6): e118-e119. doi:10.1016/j.jcct.2019.08.002 - Pubmed