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July 2002
By Theodore E. Keats, MD
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A 40-year-old man has neck pain after a motor vehicle accident.
What is your interpretation of the demonstrated lesion in
the lateral projection of his cervical spine?
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ANSWER
The patient has a calcification of the annulus fibrosus (arrow)
and not the avulsion fracture that you might expect. Unrelated
to the collision, it is an early manifestation of degenerative
disease of the cervical spine. Often, hypertrophic spurs in
that area are demonstrable in the annulus fibrosus first,
joining the vertebral body only later. Note that the small
density is additive to and not subtractive from the vertebral
body, a helpful sign in distinguishing these calcifications
from fracture.
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Emerg Med 34(7):55, 2002
This series of diagnostic quizzes that
challenge your ability to read a variety of x-ray films is edited
by Dr. Keats, professor of radiology and professor of orthopedics
at the University of Virginia School of Medicine in Charlottesville.
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