The inverted Napoleon's hat sign refers to the appearance of the L5 vertebra on frontal radiographs in patients with anterolisthesis of L5 on S1. It is formed by overlap of L5 on the sacrum on the frontal radiograph, with the vertebral body forming the dome of Napoleon's hat and the transverse processes forming tapered brim of the hat.
References
Talangbayan LE. The inverted Napoleon's hat sign. Radiology. 2007 May;243(2):603-4.
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