Pepsi sign

Case contributed by Dr Ian Bickle

Presentation

Chronic renal failure patient in dialysis. Swelling at the site of upper arm AVF.

Patient Data

Age: 45 years
Gender: Female
Ultrasound

Large saccular swelling measuring 3.5cm in the upper left arm.

Turbulent Doppler flow within.   The color Doppler demonstrates an appearance like that of Pepsi.

Case Discussion

The Pepsi sign occurs on color Doppler in the context of bidirectional flow from a false (pseudo) or a true aneurysm.

The appearance explains the origin of the name like that of a popular brand of carbonated drink.

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