Mistletoe sign

Last revised by Dr Patrick J Rock on 02 Aug 2021

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).

Differential diagnosis

Similar appearances with:

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Cases and figures

  • Figure 1: mistletoe (photo)
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  • Case 1
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