Question

In given x-ray which of the following sign is seen:

• A. Double ring sign
• B. String sign
• C. Steeple sign
• D. Thumb sign

Hint:

Two concentric rings on one plain film = the double-ring (double-wall) sign.

Answer 1

The Correct Option is A

Step 1: Read the radiograph. The image is an erect chest/abdominal radiograph in which free air outlines a structure, producing a double-walled ("ring within a ring") appearance - the classic double ring (double-wall / Rigler) sign seen when both the inner and outer surfaces of a hollow viscus become visible because gas is present on both sides (pneumoperitoneum) or air outlines a gas-containing cavity.

Step 2: Match the sign to its description. A double ring sign describes two concentric lucent/dense rings on a single film, which is exactly what this radiograph demonstrates. Hence option 1 is correct.

Step 3: Exclude the distractors by their classic settings.
- String sign: a thin string-like column of contrast through a narrowed segment - seen in Crohn disease (terminal ileum) or infantile hypertrophic pyloric stenosis on a contrast study, not on this plain film.
- Steeple sign: tapering subglottic narrowing of the tracheal air column on a neck AP film in viral croup (laryngotracheobronchitis).
- Thumb sign: an enlarged, thumb-shaped epiglottis on a lateral neck radiograph in acute epiglottitis.
None of these matches the concentric double-ring pattern on the shown film.

Final answer: 1. Double ring sign.