Further observations on the “spaghetti sign” in upper urinary tract hemorrhage

The “spaghetti sign” is recognized as a radiological sign of upper urinary tract hemorrhage. The sign was first described in the urinary bladder during intravenous urography, but it has subsequently been described on retrograde pyelography and in the urographic phase of contrast CT. We report the observation of the “spaghetti sign” in the bladder on ultrasonography and on Magnetic Resonance Urography (MRU), modalities in which the sign has not been previously described. We suggest that the observations may provide a useful guide when ultrasonography and/or MRU are employed in the search for the source of massive hematuria. We also report two additional cases of hematuria in whom the “spaghetti sign” is demonstrated in the urographic phase of contrast CT.