The so-called “Torricelli-Bernoulli sign” (T-B sign) could be a characteristic sign of gastrointestinal stromal tumor (GIST), according to the results of a retrospective study published in PLoS One. The T-B sign could also be a potential adverse prognostic factor for GIST.

“Thus, targeted therapy with [imatinib mesylate] is needed, and extensive surgery such as extended lymph node dissection or resection may be necessary,” the authors wrote. “Because of the relatively high rate of metastasis, regular and long-term follow-up care is a sine qua non.”

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The T-B sign is when the pressure of a necrotic cavity is equal to that of the intestinal tract in GIST, making liquid unable to flow out of or into the necrotic cavity of GIST.

This study showed that GISTs containing air-fluid levels were significantly different from GISTs without air-fluid levels in terms of tumor morphology, National Institutes of Health (NIH) risk category, invasion of adjacent organs, and necrosis or ulceration.

Of 51 patients with GIST, 17 had air-fluid levels and 34 had no air-fluid levels, and the majority (82.4%) of patients with air-fluid levels received open surgery. This percentage was significantly higher than that of the no air-fluid levels group (20.6%). 

All patients with air-fluid levels were treated with imatinib mesylate, whereas only 8.8% of those without air-fluid levels received the drug. 

The recurrence rate in the air-fluid levels group was 5.9% vs 2.9% in the no air-fluid levels group. Similarly, the death rate was 5.9% in the air-fluid levels group, while no deaths occurred in the no air-fluid levels group during follow-up. 

“Open surgery is commonly performed in GIST patients with air-fluid levels who also require targeted therapy with [imatinib mesylate],” the researchers concluded. “The Torricelli-Bernoulli sign could be a risk factor, adversely affecting the patient’s prognosis.”

Air-fluid levels are bubbles on computed tomography or magnetic resonance imaging scans that are detected in some patients with GIST.


Liu T, Lin G, Peng H, et al. Clinicopathological characteristics and prognosis of gastrointestinal stromal tumors containing air-fluid levels. PLoS One. 2021;16(12):e0261566. doi:10.1371/journal.pone.0261566