Bowler-hat sign: a simple principle for differentiating polyps from diverticula.
The bowler-hat sign has been described both with colonic polyps and with diverticula. The authors describe a simple principle for evaluating a bowler-hat sign in order to determine whether it is caused by a polyp or a diverticulum. If the bowler hat points toward the center of the long axis of the bowel, it represents an intraluminal structure (ie, a polyp). If, however, it points away from the center of the long axis of the bowel, it represents an extraluminal structure (ie, a diverticulum). Only if the bowler hat is located in the midline or is directly parallel to the long axis of the bowel is it impossible to classify the abnormality as a polyp or a diverticulum. The value of this principle was confirmed with both a radiographic model and a blinded review of radiographs from 37 cases demonstrating the bowler-hat sign. When a bowler hat is present on a double-contrast barium enema examination, use of this principle provides a simple and objective means of differentiating a polyp from a diverticulum.
Miller
W T
WT
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
Levine
M S
MS
Rubesin
S E
SE
Laufer
I
I
D001466:Barium Sulfate; D003106:Colon / Q000000981:diagnostic imaging; D003111:Colonic Polyps / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004241:Diverticulum, Colon / Q000000981:diagnostic imaging*; D006801:Humans; D008722:Methods; D011859:Radiography
D001466:Barium Sulfate