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H sign of sacral insufficiency fracture

Case contributed by Dr Henry Knipe


Long-standing low back pain. No history of recent trauma.

Patient Data

Age: 80 years
Gender: Female
Nuclear medicine

99mTc MDP bone scan

Intense uptake is seen bilaterally in the sacral ala regions, with less prominent uptake in the central sacrum.

Linear uptake is seen in the vertebral body of T12. Uptake consistent with degenerative disease is seen in the right knee joint, lower lumbosacral spine, shoulder joints, left sternoclavicular joint and left elbow joint.


An extensive sacral insufficiency fracture is likely to be the cause of the patient's pain.

Increased obliquely oriented sclerosis extending through the sacral ala bilaterally are seen with subtle corresponding linear lucencies on a background of diffuse osseous demineralization.

Case Discussion

Typical appearances of sacral insufficiency fracture with H sign on bone scan. 

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Case information

rID: 43267
Published: 3rd Mar 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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