Mercedes-Benz (Mercedes Star) Sign

Before the advent of cholecystography and ultrasound, the diagnosis of gallstones was difficult to make. Seventy-five to 85% of gallstones are not radiopaque. Fissures within gallstones have been known to pathologists for more than 200 years’. The first depiction of these fissures is said to have been made by Walter in 1796. They were first written about, in the medical literature, in 1931 by Karl Bauer ³ and Breuer ⁴ . The latter used the term ‘star sign’ to describe the pattern of fissuring evident on plain radiographs. H.R.C. Hay ⁵ attributed the phrase ‘Mercedes-Benz’ sign to the 1938 paper written by Burkhard Kommerell and Carlheinrich Wolpers ⁶ (Universitatsklinik der Charitd, Berlin). The actual term used by Kommerell and Wolpers was ‘Mercedes star’ (Mercedesstern). Recognition of this triradiate gas pattern (Figure 1) allows the diagnosis of cholelithiasis to be made even when the stone is only faintly visible. One must be careful not to mistake gas trapped within the folds of the gastric pylorus for the fissures in a gallstone. Figure 1 Resected specimen showing the Mercedes-star sign. ‘The gas filled cracks are especially well seen.’ Reprinted from Kommerell and Wolpers<xref ref-type="bibr" rid="ref53_5"> ⁵ </xref>. Gashaltige Gallensteine. <italic>Fortschr. Geb. Rontgenstr.,</italic> 1938,58, 156–174, with permission of Georg Thieme Verlag https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig53_1_B.jpg"/>