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Lemon sign

MedGen UID:
1671076
•Concept ID:
C4700166
•
Sign or Symptom
Synonym: lemon sign
 
HPO: HP:0032269

Definition

The lemon sign refers to the shape of the fetal skull at ultrasonography (US) when the frontal bones lose their normal convex contour and appear flattened or inwardly scalloped. This gives the skull a shape that is said to resemble a lemon.. The sign is seen on transverse sonograms of the fetal cranium obtained at the level of the ventricles. [from HPO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVLemon sign

Professional guidelines

PubMed

Prenatal diagnosis and postnatal outcome of closed spinal dysraphism.
Bedei I, Krispin E, Sanz Cortes M, Lombaard H, Zemet R, Whitehead WE, Belfort MA, Huisman TAGM
Prenat Diagn 2024 Apr;44(4):499-510. Epub 2023 Nov 27 doi: 10.1002/pd.6454. PMID: 38013494
Comparison between MRI and the Combination of 2D and 3D US in the Prenatal Diagnosis of Closed Spina Bifida.
Zhang W, Wang J, Wu H, Chen L
Pediatr Neurosurg 2023;58(6):392-400. Epub 2023 Sep 12 doi: 10.1159/000533205. PMID: 37699379
Prenatal diagnosis of spina bifida: from intracranial translucency to intrauterine surgery.
Sepulveda W, Wong AE, Sepulveda F, Alcalde JL, Devoto JC, Otayza F
Childs Nerv Syst 2017 Jul;33(7):1083-1099. Epub 2017 Jun 7 doi: 10.1007/s00381-017-3445-7. PMID: 28593553

Recent clinical studies

Etiology

Prenatal diagnosis and postnatal outcome of closed spinal dysraphism.
Bedei I, Krispin E, Sanz Cortes M, Lombaard H, Zemet R, Whitehead WE, Belfort MA, Huisman TAGM
Prenat Diagn 2024 Apr;44(4):499-510. Epub 2023 Nov 27 doi: 10.1002/pd.6454. PMID: 38013494
Comparison between MRI and the Combination of 2D and 3D US in the Prenatal Diagnosis of Closed Spina Bifida.
Zhang W, Wang J, Wu H, Chen L
Pediatr Neurosurg 2023;58(6):392-400. Epub 2023 Sep 12 doi: 10.1159/000533205. PMID: 37699379
Hindbrain Herniation and Banana and Lemon Sign After Open Fetal Myelomeningocele Repair - When Do These Signs Disappear and is Shunting Predictable?
Vonzun L, Winder FM, Meuli M, Moehrlen U, Mazzone L, Kraehenmann F, Huesler M, Zimmermann R, Ochsenbein-Kölble N
Ultraschall Med 2021 Oct;42(5):514-519. Epub 2020 Apr 24 doi: 10.1055/a-1112-7096. PMID: 32330995
The lemon sign: not a specific indicator of meningomyelocele.
Ball RH, Filly RA, Goldstein RB, Callen PW
J Ultrasound Med 1993 Mar;12(3):131-4. doi: 10.7863/jum.1993.12.3.131. PMID: 8492374
Fetal cephaloceles: diagnosis with US.
Goldstein RB, LaPidus AS, Filly RA
Radiology 1991 Sep;180(3):803-8. doi: 10.1148/radiology.180.3.1871297. PMID: 1871297

Diagnosis

Prenatal diagnosis and postnatal outcome of closed spinal dysraphism.
Bedei I, Krispin E, Sanz Cortes M, Lombaard H, Zemet R, Whitehead WE, Belfort MA, Huisman TAGM
Prenat Diagn 2024 Apr;44(4):499-510. Epub 2023 Nov 27 doi: 10.1002/pd.6454. PMID: 38013494
Comparison between MRI and the Combination of 2D and 3D US in the Prenatal Diagnosis of Closed Spina Bifida.
Zhang W, Wang J, Wu H, Chen L
Pediatr Neurosurg 2023;58(6):392-400. Epub 2023 Sep 12 doi: 10.1159/000533205. PMID: 37699379
Hindbrain Herniation and Banana and Lemon Sign After Open Fetal Myelomeningocele Repair - When Do These Signs Disappear and is Shunting Predictable?
Vonzun L, Winder FM, Meuli M, Moehrlen U, Mazzone L, Kraehenmann F, Huesler M, Zimmermann R, Ochsenbein-Kölble N
Ultraschall Med 2021 Oct;42(5):514-519. Epub 2020 Apr 24 doi: 10.1055/a-1112-7096. PMID: 32330995
Prenatal diagnosis of spina bifida: from intracranial translucency to intrauterine surgery.
Sepulveda W, Wong AE, Sepulveda F, Alcalde JL, Devoto JC, Otayza F
Childs Nerv Syst 2017 Jul;33(7):1083-1099. Epub 2017 Jun 7 doi: 10.1007/s00381-017-3445-7. PMID: 28593553
Sonographic detection of open spina bifida in the first trimester: review of the literature.
Meller C, Aiello H, Otaño L
Childs Nerv Syst 2017 Jul;33(7):1101-1106. Epub 2017 May 16 doi: 10.1007/s00381-017-3443-9. PMID: 28510070

Prognosis

Cranial findings detected by second-trimester ultrasound in fetuses with myelomeningocele: a systematic review.
Kunpalin Y, Richter J, Mufti N, Bosteels J, Ourselin S, De Coppi P, Thompson D, David AL, Deprest J
BJOG 2021 Jan;128(2):366-374. doi: 10.1111/1471-0528.16496. PMID: 32926566Free PMC Article
Hindbrain Herniation and Banana and Lemon Sign After Open Fetal Myelomeningocele Repair - When Do These Signs Disappear and is Shunting Predictable?
Vonzun L, Winder FM, Meuli M, Moehrlen U, Mazzone L, Kraehenmann F, Huesler M, Zimmermann R, Ochsenbein-Kölble N
Ultraschall Med 2021 Oct;42(5):514-519. Epub 2020 Apr 24 doi: 10.1055/a-1112-7096. PMID: 32330995
Fetal cephaloceles: diagnosis with US.
Goldstein RB, LaPidus AS, Filly RA
Radiology 1991 Sep;180(3):803-8. doi: 10.1148/radiology.180.3.1871297. PMID: 1871297
The "lemon" sign: a clinical perspective.
Filly RA
Radiology 1988 May;167(2):573-5. doi: 10.1148/radiology.167.2.3282266. PMID: 3282266
Abnormalities of fetal cranial contour in sonographic detection of spina bifida: evaluation of the "lemon" sign.
Nyberg DA, Mack LA, Hirsch J, Mahony BS
Radiology 1988 May;167(2):387-92. doi: 10.1148/radiology.167.2.3282259. PMID: 3282259

Clinical prediction guides

Prenatal diagnosis and postnatal outcome of closed spinal dysraphism.
Bedei I, Krispin E, Sanz Cortes M, Lombaard H, Zemet R, Whitehead WE, Belfort MA, Huisman TAGM
Prenat Diagn 2024 Apr;44(4):499-510. Epub 2023 Nov 27 doi: 10.1002/pd.6454. PMID: 38013494
Hindbrain Herniation and Banana and Lemon Sign After Open Fetal Myelomeningocele Repair - When Do These Signs Disappear and is Shunting Predictable?
Vonzun L, Winder FM, Meuli M, Moehrlen U, Mazzone L, Kraehenmann F, Huesler M, Zimmermann R, Ochsenbein-Kölble N
Ultraschall Med 2021 Oct;42(5):514-519. Epub 2020 Apr 24 doi: 10.1055/a-1112-7096. PMID: 32330995
The lemon sign: not a specific indicator of meningomyelocele.
Ball RH, Filly RA, Goldstein RB, Callen PW
J Ultrasound Med 1993 Mar;12(3):131-4. doi: 10.7863/jum.1993.12.3.131. PMID: 8492374
Fetal cephaloceles: diagnosis with US.
Goldstein RB, LaPidus AS, Filly RA
Radiology 1991 Sep;180(3):803-8. doi: 10.1148/radiology.180.3.1871297. PMID: 1871297
The "lemon" sign: a clinical perspective.
Filly RA
Radiology 1988 May;167(2):573-5. doi: 10.1148/radiology.167.2.3282266. PMID: 3282266

Recent systematic reviews

Cranial findings detected by second-trimester ultrasound in fetuses with myelomeningocele: a systematic review.
Kunpalin Y, Richter J, Mufti N, Bosteels J, Ourselin S, De Coppi P, Thompson D, David AL, Deprest J
BJOG 2021 Jan;128(2):366-374. doi: 10.1111/1471-0528.16496. PMID: 32926566Free PMC Article

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