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LearningRadiology Imaging Signs
on Twitter
Case of the Week 381 
What sign is depicted on this image?
- 46 year-old with back pain
Frontal radiograph of lumbar spine
1. Dense pedicle sign
2. Ivory vertebra
3. Sherlock Holmes sign
4. Spine sign
5. Napoleon hat sign
Additional Images - Lateral radiograph of lumbosacral junction
Additional Images
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Lateral radiograph of lumbosacral junction
Answer:
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5. Napoleon Hat Sign
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More (Click Discussion Tab)
Napoleon Hat Sign
General Considerations
- Occurs with marked anterolisthesis of L5 on S1
- Visible on frontal radiograph of lumbar spine
- Implies the presence of bilateral spondylolysis and significant spondylolisthesis
- Spondylolysis resulting in this degree of spondylolisthesis is more often congenital and/or traumatic in origin and less often degenerative
- "Brim" of hat is formed by the downward rotation of the transverse processes
- "Dome" of hat is body of L5
- The sign can also be seen with marked exaggeration of the normal lordosis at the lumbosacral junction
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This Week
46 year-old with back pain |
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is an award-winning educational website aimed primarily at medical students and radiology residents-in-training, containing lectures, handouts, images, Cases of the Week, archives of cases, quizzes, flashcards of differential diagnoses and “most commons” lists, primarily in the areas of chest, GI, GU cardiac, bone and neuroradiology. |
