Coexistence of ‘Friemann-Dahl sign’ and ‘Neuhauser’s sign’ in a newborn: A diagnostic dilemma

Friemann-Dahl sign is the radiological appearance of three dense lines in the abdomen converging towards the left iliac fossa. It is caused by the apposing walls of the twisted sigmoid colon (sigmoid volvulus). [1] This appearance is also variously known as the ‘omega sign’, ‘bent inner-tube sign’, ‘horse-shoe sign’, ‘convergence sign’, or ‘coffee-bean sign’. Neuhauser’s sign is a soap-bubble like appearance in the right iliac fossa. It is caused by tiny air bubbles entrapped within the viscid meconium of cystic fibrosis. [2] Originally this sign was considered pathognomonic of meconium ileus; but subsequently, it was also reported in necrotizing enterocolitis, Hirschsprung disease, and anal stenosis. [3, 4] Concomitance of both the Friemann-Dahl’s sign and the Neuhauser’s sign in a neonate caused a diagnostic dilemma.