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Related Experiment Videos

Bowler-hat sign: a simple principle for differentiating polyps from diverticula.

W T Miller1, M S Levine, S E Rubesin

  • 1Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.

Radiology
|December 1, 1989
PubMed
Summary

The bowler-hat sign on barium enema can indicate polyps or diverticula. A simple principle, observing the sign's orientation relative to the bowel's long axis, helps differentiate these colonic abnormalities.

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Area of Science:

  • Gastroenterology
  • Radiology
  • Medical Imaging

Background:

  • The bowler-hat sign is observed in colonic imaging.
  • This sign can be associated with both polyps and diverticula.
  • Differentiating between these two conditions based on the sign is crucial for diagnosis.

Purpose of the Study:

  • To present a simple principle for evaluating the bowler-hat sign.
  • To determine if the sign represents an intraluminal (polyp) or extraluminal (diverticulum) structure.
  • To provide an objective method for differentiating polyps from diverticula.

Main Methods:

  • Describing a principle based on the orientation of the bowler-hat sign relative to the bowel's long axis.
  • Validating the principle using a radiographic model.

Related Experiment Videos

  • Conducting a blinded review of 37 radiographic cases exhibiting the bowler-hat sign.

    • Main Results:

    • The principle correctly differentiates polyps (intraluminal) from diverticula (extraluminal) based on the sign's orientation.
    • Pointing toward the center indicates an intraluminal structure (polyp).
    • Pointing away from the center indicates an extraluminal structure (diverticulum).
    • Midline or parallel orientation renders classification impossible.

    Conclusions:

    • The described principle offers a simple and objective method for differentiating colonic polyps from diverticula when the bowler-hat sign is present.
    • This principle enhances diagnostic accuracy in double-contrast barium enema examinations.
    • Accurate differentiation aids in appropriate patient management and treatment planning.