On a barium meal, which of the following features on an ulcer crater would MOST favor a malignant etiology over a benign peptic ulcer?

• A Hampton's line across the mouth of the ulcer
• B Radiating mucosal folds reaching the edge of the crater
• C Carman's meniscus sign — a crescent-shaped collection within a filling defect ✓
• D Ulcer projecting beyond the expected gastric contour

Explanation

Carman's meniscus sign (Kirklin complex) is pathognomonic of malignant gastric ulcer — it describes a crescent-shaped barium collection within a mounded, non-projecting ulcer surrounded by elevated neoplastic tissue that prevents the ulcer from projecting beyond the gastric lumen. Hampton's line is a thin lucent line across the mouth of a benign peptic ulcer representing the overhanging mucosal edge. Radiating folds and projection beyond gastric contour are features of benign ulcers.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.