Learning Radiology xray montage

Sandwich Sign
Hamburger Sign

General Considerations

  • CT appearance of mesenteric fat and vessels "sandwiched" between two nodular layers of mesenteric lymphadenopathy
    • Also seen on ultrasound
  • Highly suggestive of mesenteric lymphoma
    • Usually non-Hodgkin's variety (NHL)
    • Mesenteric masses occur in 30-50% of patients with NHL
  • Frequently associated with retroperitoneal adenopathy as well
  • Sandwich sign may also be seen in patients with post-transplantation lymphoproliferative disorder

Sandwich Sign. Axial contrast-enhanced CT images of the abdomen and pelvis
demonstrate lobulated, lymphadenopathy (white arrows) "sandwiching" mesenteric vessels and fat (red arrows) in a pattern suggestive of mesenteric lymphoma. There is also retroperitoneal adenopathy (black arrows).

For more information, click on the link if you see this icon

For this same photo without the annotations, click here and here

The Sandwich Sign. Hardy, S.  Radiology,  226,  651-652.