MyPACS.net: Radiology Teaching Files > Case 12695665

Never visited COMPRESSION FRACTURE, INFERIOR ENDPLATE OF L1, NOT DETECTED ON RADIOGRAPHS
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 63 year old female
History:

Acute low back pain. Rule out disc herniation.

Images:[small]larger

Fig. 1: LATERAL L-SPINE (TAKEN 11/28/07)

Fig. 2: SAGITTAL T2 / T2 FATSAT / T1

Fig. 3: SAGITTAL T2

Fig. 4: SAGITTAL T2 FATSAT

Fig. 5: SAGITTAL T1
Findings:

MRI:
MRI of the lumbar spine reveals the following:

There is an acute to subacute centralized compression fracture deformity of the inferior endplate of L1. There are low-signal T1, high-signal T2 endplate changes. There is approximately 30% loss of vertebral body height. Comparison to prior x-ray examination does not show the endplate deformity on the inferior L1 margin. Follow up x-ray correlation is advised. There is no retropulsion of vertebral tissue into the spinal canal. There is no compromise of the conus medullaris or cauda equina.


The remaining vertebral bodies of the lumbar spine are unremarkable. There are reactive Modic I degenerative changes noted on the right anterior inferior aspect of the L2 vertebral body. Intervertebral discs overall show adequate hydration with minimal annular bulge. There is no herniation of nuclear material. The spinal canal caliber is normal. Incidentally observed is a 2 cm round Tarlov cyst on the right side of the second sacral level. Paraspinal lumbar musculature is symmetric but does show marked atrophy. There is a moderate-sized renal cyst on the inferior pole of the left kidney measuring approximately 5 cm. Otherwise, the retroperitoneal structures are unremarkable.

XRAY:

X-ray examination of the right hand does not reveal any fracture or aggressive bone abnormality. There is suggestion of disc space narrowing in the metacarpal phalangeal joints. No definitive articular erosions are identified, but there is suggestion on the oblique films of juxta-articular osteopenia. These changes may represent an inflammatory arthropathy. Clinical correlation advised. Mild degenerative changes of the thumb carpal metacarpal joint are identified.

Diagnosis:

MRI:
1. ACUTE TO SUBACUTE CENTRALIZED COMPRESSION DEFORMITY OF THE INFERIOR L1 VERTEBRAL BODY. THIS ENDPLATE DEFORMITY WAS NOT PRESENT IN THE X-RAY EXAMINATION OF 11/28/07. CLINICAL CORRELATION ADVISED. NO MARROW LESIONS ARE REVEALED ON THIS EXAM AND THUS MOST PROBABLE ETIOLOGY IS TRAUMA AND/OR OSTEOPOROSIS.

2. MINIMAL CONCENTRIC ANNULAR BULGING NOTED THROUGHOUT THE LUMBAR SPINE WITHOUT ANY SIGNIFICANT LOSS OF DISC HEIGHT OR HERNIATION OF NUCLEAR MATERIAL.

3. ADVANCED ATROPHY OF THE POSTERIOR LUMBAR MUSCULATURE.

4. 5 CM RENAL CYST, INFERIOR POLE OF LEFT KIDNEY.

5. LEFT CONVEX SCOLIOSIS.
 
XRAY:

1. NO FRACTURE OR AGGRESSIVE BONE OR JOINT ABNORMALITY OF THE RIGHT HAND.

2. EQUIVOCAL SUGGESTION OF METACARPAL PHALANGEAL JOINT NARROWING AND JUXTA-ARTICULAR OSTEOPENIA. CLINICAL CORRELATION FOR INFLAMMATORY ARTHROPATHY.

References:

REFERRING PHYSICIAN: MARK SCHULZ, DC

Comments:
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Additional Details:

Case Number: 12695665Last Updated: 01-11-2008
Anatomy: Spine and Peripheral Nervous System   Pathology: Trauma
Modality: Conventional Radiograph, MRAccess Level: Readable by all users

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