THE MERCEDES-BENZ SIGN: INSIGHT INTO THE DYNAMICS OF FORMATION AND DISAPPEARANCE OF GALLSTONES

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Abstract
The Mercedes-Benz sign, a distinctive pattern of usually triradiate radiolucent branching, represents the common but often clinically overlooked phenomenon of gas-fissuring within gallstones. Twenty-eight reports have been collected from the literature. The observation not only permits the plain film roentgenographic diagnosis of nonopaque calculi, but provides an insight into the physiochemical processes of cholelithogenesis. Two cases are reported and illustrated, in 1 of which spontaneous disappearance of the gallstone occurred. The correlation of gas fissuring of gallstones to the dynamics of calculus formation and their autofragmentation and spontaneous passage through the ductal system is discussed. Propensity to spontaneous passage also appears related to the specific gravity of bile strata and the influence of contraction of the gallbladder. Emphasis is placed on the roentgenologic features and differential diagnosis.

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