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Apple core sign (colon)

Changed by Craig Hacking, 18 Jan 2024

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Disclosures - updated 3 May 2023:

Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)

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The apple core sign, also known as the napkin ring sign (bowel), is most frequently associated with constriction of the lumen of the colon by by a stenosing annular colorectal carcinoma.

It is not to be confused with the napkin-ring sign of vulnerable coronary artery plaque or the apple core sign of the femur.

Differential diagnosis

The appearance of the apple-core lesion of the colon also can be caused by other diseases ³:

lymphoma with colonic involvement - appears more diffuse
Crohn disease
chronic ulcerative colitis
ischaemic colitis
chlamydia infection
colonic tuberculosis
helminthoma
colonic amoebiasis
colonic cytomegalovirus
villous adenoma
radiosurgery e e.g. ~~high~~ high dose CyberKnife used for treating unresectable abdominal malignancies

~~See also~~

~~napkin-ring sign (cardiac)~~

~~apple core sign (femur)~~

-The apple core sign, also known as the napkin ring sign (bowel), is most frequently associated with constriction of the lumen of the <a href="/articles/large-intestine-1">colon</a> by a stenosing annular <a href="/articles/colorectal-cancer-1">colorectal carcinoma</a>.<h4>Differential diagnosis</h4>The appearance of the apple-core lesion of the colon also can be caused by other diseases 3:<ul>
~~-<li>~~
~~-<a href="/articles/large-bowel-lymphoma">lymphoma with colonic involvement</a> - appears more diffuse</li>~~
~~-<li><a href="/articles/crohn-disease-1">Crohn disease</a></li>~~
~~-<li><a href="/articles/ulcerative-colitis">chronic ulcerative colitis</a></li>~~
~~-<li><a href="/articles/ischaemic-colitis">ischaemic colitis</a></li>~~
~~-<li>chlamydia infection</li>~~
~~-<li><a href="/articles/colonic-tuberculosis">colonic tuberculosis</a></li>~~
~~-<li><a href="/articles/helminthoma">helminthoma</a></li>~~
~~-<li><a href="/articles/amoebic-colitis">colonic amoebiasis</a></li>~~
~~-<li><a href="/articles/gastrointestinal-cytomegalovirus-infection">colonic cytomegalovirus</a></li>~~
~~-<li><a href="/articles/colorectal-villous-polyps">villous adenoma</a></li>~~
~~-<li>~~
~~-<a href="/articles/stereotactic-radiosurgery">radiosurgery</a> e.g. high dose <a href="/articles/cyberknife-1">CyberKnife</a> used for treating unresectable abdominal malignancies</li>~~
~~-</ul><h4>See also</h4><ul>~~
~~-<li><a href="/articles/napkin-ring-sign-heart">napkin-ring sign (cardiac)</a></li>~~
~~-<li><a href="/articles/apple-core-sign-femur-1">apple core sign (femur)</a></li>~~
+The apple core sign, also known as the napkin ring sign (bowel), is most frequently associated with constriction of the lumen of the <a href="/articles/large-intestine-1">colon</a> by a stenosing annular <a href="/articles/colorectal-cancer-1">colorectal carcinoma</a>.It is not to be confused with the <a href="/articles/napkin-ring-sign-heart">napkin-ring sign</a> of vulnerable coronary artery plaque or the <a href="/articles/apple-core-sign-femur-1">apple core sign</a> of the femur.<h4>Differential diagnosis</h4>The appearance of the apple-core lesion of the colon also can be caused by other diseases 3:<ul>
+<li><a href="/articles/large-bowel-lymphoma">lymphoma with colonic involvement</a> - appears more diffuse</li>
+<li><a href="/articles/crohn-disease-1">Crohn disease</a></li>
+<li><a href="/articles/ulcerative-colitis">chronic ulcerative colitis</a></li>
+<li><a href="/articles/ischaemic-colitis">ischaemic colitis</a></li>
+<li>chlamydia infection</li>
+<li><a href="/articles/colonic-tuberculosis">colonic tuberculosis</a></li>
+<li><a href="/articles/helminthoma">helminthoma</a></li>
+<li><a href="/articles/amoebic-colitis">colonic amoebiasis</a></li>
+<li><a href="/articles/gastrointestinal-cytomegalovirus-infection">colonic cytomegalovirus</a></li>
+<li><a href="/articles/colorectal-villous-polyps">villous adenoma</a></li>
+<li><a href="/articles/stereotactic-radiosurgery">radiosurgery</a> e.g. high dose <a href="/articles/cyberknife-1">CyberKnife</a> used for treating unresectable abdominal malignancies</li>

Images Changes:

Image 2 Photo ( create )

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Figure 2: napkin ring

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Image 3 Diagram ( update )

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Figure 23: apple-core lesion

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Image 4 Diagram ( update )

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Figure 24: apple-core lesion

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Image 5 Pathology (Gross pathology) ( update )

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Figure 34: gross pathology - colorectal cancer

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Image 6 Fluoroscopy (Lateral) ( update )

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Image 7 CT (Virtual colonoscopy) ( update )

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Image 8 Fluoroscopy ( update )

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Image 9 Barium (Frontal) ( update )

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Image 10 Barium (Oblique) ( update )

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Image 11 CT (C+ portal venous phase) ( update )

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Image 12 Fluoroscopy (Lateral) ( update )

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Image 13 CT (C+ portal venous phase) ( update )

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