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May 2004
By Joel M. Schwartz, MD
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When her vehicle crashes into a guard rail at 50 mph,
a 33-year-old female driver, who was wearing a combination
seat/lap belt, sustains bilateral chest contusions and
is brought to your emergency department. She complains
of focal back pain. As part of a bilateral rib series
to evaluate for fracture, this anteroposterior view
is obtained. What does it tell you about her condition?
CLICK HERE FOR ANSWER
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ANSWER
The patient's anteroposterior radiographic view reveals
abnormal morphology of the T12 vertebral body, which
is shorter and wider than the adjacent vertebral bodies.
A cleft can also be identified in the midline. To further
evaluate for suspected fracture, axial computed tomography
was performed. The images demonstrated that the cleft
was well corticated and extended through about two thirds
of the length of the body (see image below, left). A
bony bridge is visible across the two halves of the
vertebral body anteriorly. Two-dimensional reformatted
images through the posterior aspect of the vertebral
body (see image below, right) show the unfused portions
of the lateral masses of the vertebral body. The constellation
of imaging findings is consistent with a congenital
malformation and not a fracture. This is a variation
of a butterfly vertebral body, in which the two lateral
ossification centers typically do not fuse at all; in
her case there was partial fusion anteriorly.
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Dr Schwartz is a senior attending radiologist
at Nyack Hospital in Nyack, New York. This series of diagnostic
quizzes that challenge your ability to read a variety of x-ray
films is edited by Theodore E. Keats, MD, alumni professor
of radiology at the University of Virginia School of Medicine
in Charlottesville.
Emerg Med 36(5):53, 2004
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