Trident sign (neurosarcoidosis)
Citation, DOI, disclosures and article data
Citation:
Sharma R, Glick Y, Jones J, et al. Trident sign (neurosarcoidosis). Reference article, Radiopaedia.org (Accessed on 22 Mar 2025) https://doi.org/10.53347/rID-172832
Permalink:
rID:
172832
Article created:
Disclosures:
At the time the article was created Rohit Sharma had no financial relationships to ineligible companies to disclose.
View Rohit Sharma's current disclosures
Last revised:
Disclosures:
At the time the article was last revised Yaïr Glick had no financial relationships to ineligible companies to disclose.
View Yaïr Glick's current disclosures
Revisions:
9 times, by
5 contributors -
see full revision history and disclosures
Systems:
Sections:
Tags:
Synonyms:
- Trident sign (spinal cord)
The trident sign is a radiological (MRI) sign described in spinal cord neurosarcoidosis.
The sign is formed by the axial appearance of a longitudinally extensive transverse myelitis due to spinal cord neurosarcoidosis, whereby on a T1-weighted post-contrast (gadolinium) MRI sequence, there is central canal enhancement in addition to crescent-shaped posterior subpial enhancement 1-3. This gives the appearance of a trident, a three-pronged spear 1-3.
It has been suggested that this is a useful sign in differentiating neurosarcoidosis from other causes of longitudinally extensive transverse myelitis, such as neuromyelitis optica spectrum disorder (NMOSD) 3. However, it should be noted that while it may be characteristic, the trident sign may not be commonly present in cases of spinal cord neurosarcoidosis; for example, it was not found in any cases in one large case series of patients with the condition 4. It is also not specific for neurosarcoidosis and can be seen in other pathologies (e.g. HTLV-1-associated myelopathy, spinal cord primary CNS lymphoma) 6,7.
History and etymology
The trident is a three-pronged lance used for spear fishing. In classical mythology, it was the weapon borne by sea gods (Poseidon in Ancient Greece or Neptune in Roman mythology) 5. A similar weapon, the trishoola, with rounded tines, is also seen being carried in images of Hindu gods (Shiva and Durga) 5. The trident sign was first employed in the context of neurosarcoidosis in 2016 1.
References
- 1. Zalewski N, Krecke K, Weinshenker B et al. Central Canal Enhancement and the Trident Sign in Spinal Cord Sarcoidosis. Neurology. 2016;87(7):743-4. doi:10.1212/WNL.0000000000002992 - Pubmed
- 2. Gibbons E, Whittam D, Jacob A, Huda S. Images of the Month 1: Trident Sign and Neurosarcoidosis. Clin Med (Lond). 2021;21(6):e667-8. doi:10.7861/clinmed.2021-0596 - Pubmed
- 3. Jolliffe E, Keegan B, Flanagan E. Trident Sign Trumps Aquaporin-4-IgG ELISA in Diagnostic Value in a Case of Longitudinally Extensive Transverse Myelitis. Mult Scler Relat Disord. 2018;23:7-8. doi:10.1016/j.msard.2018.04.012 - Pubmed
- 4. Nolte J, Ten Dam L, van de Beek D, Brouwer M. Clinical Characteristics and Outcome of Neurosarcoidosis-Associated Myelitis: A Retrospective Cohort Study and Review of the Literature. Eur J Neurol. 2022;29(6):1763-70. doi:10.1111/ene.15295 - Pubmed
- 5. Agrawal A. Musculoskeletal Colloquialisms Based on Weapons. J Clin Orthop Trauma. 2017;8(1):1-10. doi:10.1016/j.jcot.2016.07.006 - Pubmed
- 6. Dixon L, McNamara C, Dhasmana D, Taylor G, Davies N. Imaging Spectrum of HTLV-1-Related Neurologic Disease: A Pooled Series and Review. Neurol Clin Pract. 2023;13(3):e200147. doi:10.1212/CPJ.0000000000200147 - Pubmed
- 7. Griffin K, Toledano M, Flanagan E, Mustafa R. “Trident Sign” in Primary CNS B-Cell Spinal Cord Lymphoma. Neurology. 2023;101(19):857-8. doi:10.1212/wnl.0000000000207671
Incoming Links
Related articles: Inspired signs
-
inanimate object inspired
- accordion sign
- astronomical inspired[+][+]
- ball of wool sign
- ball on tee sign (renal papillary necrosis)
- boot-shaped heart
- bowler hat sign
- bow tie sign[+][+]
- box-shaped heart
- bucket handle appearance (disambiguation)[+][+]
- chain of lakes sign
- champagne glass pelvis
- cobblestone appearance
- Coca-Cola bottle sign
- cockade sign (disambiguation)[+][+]
- coin lesion
- collar button ulcer
- comb sign
- corduroy artifact
- corduroy sign
-
corkscrew sign (disambiguation)[+][+]
- corkscrew sign (diffuse esophageal spasm)
- corkscrew sign (inner ear)
- corkscrew sign (midgut volvulus)
- crazy paving sign
- cupola sign
- curtain sign (lung ultrasound)
- dinner fork deformity
- dripping candle wax sign
- finger in glove sign
- fishhook ureters
- flame-shaped breast (gynecomastia)
- football sign (pneumoperitoneum)
- frozen pelvis
- ghost triad (gallbladder)
- ghost vertebra
- goblet sign
- ground glass opacity
- hockey stick sign (disambiguation)[+][+]
- horseshoe (disambiguation)[+][+]
- hourglass sign
- hurricane sign (cardiac SPECT)
- jail bar sign
- keyhole sign (disambiguation)[+][+]
- leather bottle stomach
- light bulb sign (disambiguation)[+][+]
- Lincoln log vertebra
- Mercedes-Benz sign (disambiguation)[+][+]
- misty mesentery sign
- mosaic appearance (disambiguation)[+][+]
- napkin ring sign
- open book fracture
- pearl necklace sign
- pencil in a cup
- picture frame vertebral body
- polka-dot sign
- rachitic rosary
- ribbon rib deformity
- ring shadow
- rugger jersey spine
- sack of marbles sign
- sail sign (disambiguation)[+][+]
- scalpel sign
- spilled teacup sign
- stepladder sign (disambiguation)[+][+]
-
string of pearls sign (disambiguation)[+][+]
- string of pearls sign (abdominal radiograph of small bowel)
- string of pearls sign (polycystic ovarian syndrome)
- string of pearls sign (fibromuscular dysplasia)
- string of pearls sign (watershed infarction)
- Tam o' Shanter sign
- telephone receiver deformity
- thimble bladder
- tombstone iliac wings
- Venetian blind sign
- Venus necklace sign
- water bottle sign
-
weapon and munition inspired signs
- arrowhead sign
- bayonet artifact
- bayonet deformity
- boomerang sign (disambiguation)[+][+]
- bullet-shaped vertebra
- cannonball metastases
- Cupid bow contour
- dagger sign
- double barrel sign
- halberd pelvis
- hatchet sign
- panzerherz
- pistol grip deformity
- saber-sheath trachea
- scimitar syndrome
-
target sign (disambiguation)[+][+]
- double target sign (hepatic abscess)
- eccentric target sign (cerebral toxoplasmosis)
- reverse target sign (cirrhotic nodules)
- target sign (cholangiocarcinoma)
- target sign (choledocholithiasis)
- target sign (hepatic metastases)
- target sign (intussusception)
- target sign (neurofibromas)
- target sign (pyloric stenosis)
- target sign (tuberculosis)
-
trident appearance
- trident acetabulum
- trident hand
- trident sign (osmotic demyelination)
- trident sign (neurosarcoidosis)
- trident sign (persistent primitive trigeminal artery)
- Viking helmet sign
- white pyramid sign
- windswept knees
- wine bottle sign
-
vegetable and plant inspired[+][+]
- aubergine sign
- bamboo spine
- blade of grass sign
- celery stalk appearance (disambiguation)
- coconut left atrium
- coffee bean sign
- cotton wool appearance
- drooping lily sign
- ginkgo leaf sign (disambiguation)
- holly leaf sign
- iris sign
- ivy sign
- miliary opacities
- mistletoe sign
- onion signs (disambiguation)
- pine cone bladder
-
popcorn calcification (disambiguation)
- popcorn calcification (breast)
- popcorn calcification (chondroid lesions)
- popcorn calcification (fibrous dysplasia)
- popcorn calcification (osteogenesis imperfecta)
- popcorn calcification (pulmonary hamartomas)
- popcorn calcification (uterine fibroid)
- potato nodes
- rice signs (disambiguation)
- salt and pepper sign (disambiguation)
- tombstone iliac wings
- tree-in-bud
- tulip sign
- water lily sign
-
fruit inspired[+][+]
- apple core sign (disambiguation)
- apple-peel intestinal atresia
- banana and egg sign
- banana fracture
- banana sign
- berry aneurysm
- bowl of grapes sign
-
bunch of grapes sign (disambiguation)
- bunch of grapes sign (hydatidiform mole)
- bunch of grapes sign (bronchiectasis)
- bunch of grapes sign (IPMN)
- bunch of grapes sign (botryoid rhabdomyosarcoma)
- bunch of grapes sign (intracranial tuberculoma)
- bunch of grapes sign (intraosseous hemangiomas)
- bunch of grapes sign (multicystic dysplastic kidney)
- cashew nut sign
- lemon sign
- pear-shaped bladder
- strawberry gallbladder
- strawberry skull
- watermelon skin sign
-
animal and animal produce inspired[+][+]
- human
- mammals
- anteater nose sign
- antler sign
- batwing opacities
- bear paw sign
- beaver tail liver
- Brahma bull sign
- buffalo chest
- bull's eye sign (disambiguation)
- bunny waveform sign
- claw sign
- dog ear sign
- dog leg sign
- dromedary hump
- ears of the lynx sign
- eye of tiger sign
- feline esophagus
- giraffe pattern
- hidebound sign
- ivory phalanx
- ivory vertebra sign
- joint mouse
- leaping dolphin sign
- leopard skin sign
- moose head appearance
- panda sign
- piglet sign
- pleural mouse
- raccoon eyes sign
- rat bite erosions
- rat-tail sign
- Scottie dog sign
- Snoopy sign
- stag's antler sign
- staghorn calculus
- tiger stripe sign
-
zebra sign (disambiguation)
- zebra sign: (cerebellar hemorrhage)
- zebra spleen: arterial phase (spleen)
- zebra stripe sign (osteogenesis imperfecta)
- amphibians
- birds
- bird beak sign (disambiguation)
- bird's nest sign (lung)
- crow feet sign
- egg on a string sign
- eggshell calcification (breast)
- eggshell calcification (lymph nodes)
- gooseneck sign (endocardial cushion defect)
- gull wing appearance
- hummingbird sign
- owl eyes sign
- pooping duck sign
- sitting duck appearance
- swallowtail sign
- swan neck deformity
- winking owl sign
- fish and marine life
- reptiles
- arthropods
- micro-organisms
- fictional creatures
-
food inspired[+][+]
- Cheerio sign (disambiguation)
- chocolate cyst
- cottage loaf sign
- double Oreo cookie (glenoid labrum)
- doughnut sign (disambiguation)
- hamburger sign (spine)
- head cheese sign (lungs)
- honeycombing (lungs)
- hot cross bun sign (pons)
- ice cream cone sign (middle ear ossicles)
- ice cream cone sign (vestibular schwannoma)
- licked candy stick appearance (bones)
- linguine sign (breast implants)
- macaroni sign
- omental cake
- Oreo cookie (heart)
- pancake organ (disambiguation)
- Polo mint sign
- salad oil sign (breast implants)
- sandwich sign (disambiguation)
- sandwich vertebra
- sausage digit
- spaghetti sign
- Swiss cheese sign
-
alphabet inspired[+][+]
- A line (US artifact)
- C sign (MSK)
- delta sign (disambiguation)
- E sign
- H-shaped vertebra
- H sign
- J-shaped sella
- J sign (shoulder)
- L sign (brain)
- lambda sign (disambiguation)
- M sign
- omega epiglottis
- O sign (gastric banding)
- P sign (epiglottis)
- S sign of Golden
- tau sign
- T sign (disambiguation)
- U fibers
- U-figure (pelvis)
- U sign (brain)
- V sign (disambiguation)
- W hernia
- X-marks-the-spot sign
- Y sign (epidural lipomatosis)
- Z deformity
-
Christmas inspired[+][+]
- Christmas tree bladder in neurogenic bladder
- holly leaf sign in calcified pleural plaques
- ivy sign in leptomeningeal enhancement
- nutcracker esophagus in esophageal dysmotility
- shepherd's crook deformity of the femur in fibrous dysplasia
- snowcap sign in avascular necrosis
- snowman sign (disambiguation)
- snowstorm appearance in complete hydatidiform mole and testicular microlithiasis
- miscellaneous[+][+]
Unable to process the form. Check for errors and try again.