On CT urogram, a renal transitional cell carcinoma (TCC) of the upper ureter produces which classic appearance?

• A Nephrocalcinosis with striated nephrogram
• B Stellate scar with spoke-wheel enhancement
• C Bosniak IV cystic mass with enhancing nodule
• D 'Goblet sign' — the mass distends the ureter around it, creating a cup-shaped filling defect ✓

Explanation

The goblet sign (also called Bergman's sign) on CT urogram or IVP describes a TCC that distends and expands the ureteral lumen around it, forming a cup or goblet shape above the obstructing lesion. This is because urothelial tumours are softer than the surrounding ureter, which dilates above the lesion but conforms around it. This distinguishes it from calculi (which show high density) and extrinsic compression (which narrows without goblet shape). Stellate scar with spoke-wheel enhancement is characteristic of focal nodular hyperplasia of the liver.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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