The 'trumpeting elephant' sign

摘要

Elephants are often observed to raise their trunks in order to produce a "vocalization," be it either in anger or under more playful circumstances. A large column of barium refiuxing from the proximal stomach and extending superiorly into the esophagus, as seen during a barium upper gastrointestinal series (UGI), has been likened to the appearance of a trumpeting elephant (Fig. 1, 2) [1]. Gastroesophageal reflux disease (GERD) is particularly common in the Western world today, with an estimated prevalence of 10-20% [2]. Fluoroscopic examination of the esophagus and stomach is widely available, cost effective, and useful for the diagnosis of both GERD and a number of secondary complications of gastroesophageal reflux including reflux esophagitis, mucosal ulceration, esopha-geal strictures, and esophageal rings [2, 3]. The trumpeting elephant sign is highly specific for GERD, so next time you find yourself in the fiuoroscopy suite, be sure to "listen" for the mighty roar of the trumpeting elephant.