The cottage loaf sign, medically speaking

Panel A ‘Cottage loaf’, ‘snowman’ or ‘figure of 8’ heart shape due to total anomalous pulmonary venous drainage, image reproduced with kind permission of the Images in Pediatric Cardiology journal. Panel B Outline of cottage loaf. Panel C Cottage loaf (a rustic traditional English loaf of bread made with yeast and white flour) consisting of two parts, the upper part is smaller than the lower part, image from Wikimedia Commons the free media repository.

Certain medical images evoke memories of a cottage loaf (a traditional English loaf of bread – pictured here):

The cottage loaf sign can be found in right-sided diaphragmatic rupture where the herniated liver is constricted by the diaphragm at the rupture site. A smaller portion of the liver is separated from the larger portion of the liver by the diaphragmatic constriction giving a radiologic look akin to a cottage loaf (here is a picture). [Hussain M, Al Damegh S. Food Signs in Radiology. Int J Health Sci (Qassim), 2007 1(1):143–154.]

Additionally – on ultrasound scan – the cottage loaf appearance has been described with choroidal melanoma (an eye tumor); when this tumor breaks through Bruch’s membrane a bilobed mass not unlike a cottage loaf results (here is a picture). [Aironi VD, Gandage SG. Pictorial essay: B-scan ultrasonography in ocular abnormalities. Indian J Radiol Imaging, 2009 19(2): 109–115.]

BONUS: Here is a fuller account of what the image pictured here depicts.