“Playboy Rabbit” sign: What's your diagnosis?

Nicola Mumoli; Marco Cei

The Case: A 35-year-old, otherwise healthy woman arrived with complaints of shortness of breath and abdominal pain. Results of a physical examination, electro- and echocardiography, and chest radiography were all normal. An ultrasound scan of the liver was done (Fig. 1). What is your diagnosis?

Fig. 1: Ultrasound image of the patient's liver.

Answer to Clinical Vistas: “Playboy Rabbit” sign

The Diagnosis: The ultrasound scan showed a rabbit-shaped image caused by the confluence of the middle and right hepatic veins. The strongly suggestive image, also known as Mumoli's sign (named after the senior author), shows the hepatic veins joining together into the inferior vena cava. It is highly reproducible with a transverse subcostal view in deep inspiration during ultrasound scanning of the normal liver.

We were unable to find any previous report describing a rabbit-like sign.

The patient was given assurance that she had no physical abnormality and was discharged with a diagnosis of anxiety. Indeed, the woman returned immediately to her work as a waitress in a nightclub.

In the preface to the first edition of his Principles of Internal Medicine, Tinsley R. Harrison stated that physicians need “technical skill, scientific knowledge, and human understanding ... courage, humility, and wisdom.”1 Although these words have proven true many times, we believe that a little bit of curiosity and humour can help physicians to face their heavy duty to serve the suffering human being.

And sometimes, upon receiving the results of an imaging scan, one simply has to do a double-take.