Cosmic Signs in Radiology: A Pictorial Review
Abstract
1. Introduction
2. Cosmic Signs
2.1. Comet-Tail Artifact
2.1.1. On Ultrasound (US)
2.1.2. On Computed Tomography (CT)
Chest
Abdomen and Pelvis
2.1.3. On Magnetic Resonance Imaging
2.2. Earth-Heart Sign
2.3. Galaxy Sign
2.4. Loss of Half-Moon Overlap Sign
2.5. Milky Way Sign
2.5.1. On Breast Imaging
2.5.2. In Neuroimaging
2.6. Starfield Pattern
2.7. Star Sign
2.8. Starry Sky Appearance
2.8.1. On Ultrasound
2.8.2. On MRI
2.9. Sunburst Appearance and Sign
2.9.1. On Skeletal Imaging
2.9.2. In Neuroimaging
Meningioma
Agenesis of the Corpus Callosum
2.9.3. On Abdominal Imaging
2.10. Twinkling Artifact
2.11. Crescent Sign
2.11.1. On Pyelography
2.11.2. On Conventional Radiographs
2.12. Hyperdense Cresent Sign
2.13. Lateral Crescent Sign
2.14. Air Crescent Sign
2.15. Halo Sign
2.15.1. On Ultrasound
2.15.2. On CT
2.16. Fat Halo Sign
2.17. Reversed Halo Sign (Atoll Sign)
3. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Sign | Modality | Typical Pathology | Specificity | Clinical Importance |
---|---|---|---|---|
Crescent Sign | Contrast-enhanced CT | Severe hydronephrosis | Moderately specific when seen in corticomedullary phase; transient | Indicates severe obstruction; must be correlated with other signs of hydronephrosis for confirmation. |
AVN Crescent Sign | Radiograph/MRI | Stage III avascular necrosis of femoral head | Highly specific for subchondral collapse | Predicts imminent structural failure of femoral head; crucial for staging and surgical planning. |
Hyperdense Crescent | Non-contrast CT | Abdominal aortic aneurysm (AAA) | High specificity for aneurysm wall instability | Reliable harbinger of impending rupture; mandates urgent vascular consultation. |
Lateral Crescent | CT pelvis | Direct inguinal hernia | Specific for distinguishing direct vs. Indirect hernia | Helps guide surgical approach and repair strategy. |
Air Crescent Sign | CT chest | Invasive pulmonary aspergillosis (IPA), cavitary lung disease | Seen in ~50% of IPA cases; not exclusive | Often coincides with neutrophil recovery in IPA, improving prognosis; must be interpreted with clinical and microbiological data. |
Sign | Modality | Typical Pathology | Specificity | Clinical Importance |
---|---|---|---|---|
Halo Sign (CT chest) | CT (thorax) | Early invasive pulmonary aspergillosis, hemorrhagic metastases, vasculitis, COVID-19 pneumonia | Sensitive but not specific; overlaps with infection and inflammation | Recognized early markers in immunocompromised patients; prompts antifungal therapy but requires correlation with clinical/lab data. |
Halo Sign (Ultrasound, GCA) | Ultrasound (temporal and axillary arteries) | Giant cell arteritis (arterial wall inflammation) | High specificity when intima-media thickening ≥ 1 mm (sensitivity 88%, specificity 96%) | First-line imaging finding for suspected GCA; can obviate need for temporal artery biopsy in many patients. |
Fat Halo Sign | CT abdomen | Chronic inflammatory bowel disease (esp. Crohn’s, UC); also obesity, cytoreductive therapy | Low specificity; may also be seen in non-IBD contexts | Suggests chronicity of bowel inflammation; must be interpreted cautiously, not diagnostic on its own. |
Reversed Halo (Atoll) Sign | CT chest | Organizing pneumonia; also vasculitis, fungal infections, COVID-19 pneumonia | Moderate specificity for organizing pneumonia | Expands differential diagnosis; important radiologic clue but requires clinical integration and follow-up imaging. |
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Jabbour, Y.; El Alam, R.; Amro, S.; Kassas, M.; Ghosn, Y.; Chahine, R.; Khdhir, M.; Nassar, L. Cosmic Signs in Radiology: A Pictorial Review. Diagnostics 2025, 15, 2528. https://doi.org/10.3390/diagnostics15192528
Jabbour Y, El Alam R, Amro S, Kassas M, Ghosn Y, Chahine R, Khdhir M, Nassar L. Cosmic Signs in Radiology: A Pictorial Review. Diagnostics. 2025; 15(19):2528. https://doi.org/10.3390/diagnostics15192528
Chicago/Turabian StyleJabbour, Yara, Raquelle El Alam, Sara Amro, Mutaz Kassas, Youssef Ghosn, Reve Chahine, Mihran Khdhir, and Lara Nassar. 2025. "Cosmic Signs in Radiology: A Pictorial Review" Diagnostics 15, no. 19: 2528. https://doi.org/10.3390/diagnostics15192528
APA StyleJabbour, Y., El Alam, R., Amro, S., Kassas, M., Ghosn, Y., Chahine, R., Khdhir, M., & Nassar, L. (2025). Cosmic Signs in Radiology: A Pictorial Review. Diagnostics, 15(19), 2528. https://doi.org/10.3390/diagnostics15192528