MyPACS.net: Radiology Teaching Files > Case 12339069

previously visited L1 COMPRESSION FRACTURE AND ANYEURYSM
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 54 year old male
History:

Compression fracture, L1. Assessment of compression deformity, L1.


Images:[small]larger

Fig. 1: AP L-SPINE

Fig. 2: LATERAL L-SPINE

Fig. 3: AP SPOT L-SPINE

Fig. 4: LATERAL SPOT L-SPINE

Fig. 5: SAGITTAL T2

Fig. 6: SAGITTAL T2

Fig. 7: SAGITTAL T2 FATSAT

Fig. 8: SAGITTAL T1

Fig. 9: SAGITTALS
Findings:

MRI:
MRI examination confirms the presence of a compression fracture deformity of L1 with approximately 30-40% loss of vertebral anterior and central body height. There are marked low signal T1, high signal T2 changes within the vertebral body of L1 extending into the pedicles indicative of an active (acute to subacute) compression fracture process. Additionally, there are multiple endplate defects on the superior endplate of L1. There are no retropulsion fragments into the spinal canal. No herniation of nuclear material is identified of either the T12-L1 or L1-L2 discs. There is mild reactive edema on the posterior inferior margin of the T12 vertebral body.


L5-S1: This intervertebral disc shows mild desiccation and moderate loss of disc height with dorsal spondylosis and annular bulge measuring 3 mm. There is no compression of the neurological structures.


The remaining vertebral bodies of the lumbar spine are well maintained. The spinal canal caliber, conus medullaris is unremarkable. Posterior elements and facet joints of the lumbar spine show proper morphology. There is no neural foraminal or lateral recess stenosis.


In the retroperitoneum, there is a focal aneurysm at the level of L3-L4 just prior to the aortic bifurcation clearly seen on sagittal images 4 and axial T2 image #11. This aneurysm measures 3 cm. No other retroperitoneal abnormality is identified. The posterior lumbar musculature shows asymmetry and moderate atrophy with the atrophy more pronounced on the right side.



XRAY:
Examination shows a compression fracture/deformity of the L1 vertebral body with approximately 30% loss of anterior vertebral body height. There is irregularity and loss of bone density of the superior endplate more pronounced on the left anterolateral margin. This is compatible with an acute to subacute fracture. There is a possibility that this may be a superimposed or exacerbated fracture on a prior compression deformity. If prior films exist previous to 11/20/07, correlation would be beneficial. In the absence of such correlation, MRI follow up is recommended if there is clinical necessity for assessment of the vertebral body and/or spinal canal.


Also identified on this examination is aneurysmal dilatation of the abdominal aorta at the L3-4 level. This is outlined by calcific atherosclerosis and is clearly seen on the lateral and frontal projections. The aneurysmal dilatation measures approximately 3.9 cm in the lateral view. A curvilinear soft tissue density is clearly seen left lateral to the L3 vertebral body on the AP view. There is also extensive calcification of the iliac arteries.

 

Diagnosis:

MRI:
1. ACUTE TO SUBACUTE COMPRESSION FRACTURE OF L1 WITH APPROXIMATELY 40% LOSS OF ANTERIOR AND CENTRAL VERTEBRAL BODY HEIGHT.

2. ABDOMINAL AORTIC ANEURYSM MEASURING 3 CM AT THE LEVEL OF L3-L4.

3. MODERATE DEGENERATIVE DISC DISEASE WITH DORSAL BULGING AND SPONDYLOSIS MEASURING 3 MM AT L5-S1; NO NEURAL COMPRESSION.

4. MODERATE ATROPHY AND ASYMMETRY OF THE POSTERIOR LUMBAR MUSCULATURE WITH ATROPHY MORE PRONOUNCED IN THE RIGHT PARASPINAL MUSCULATURE.



XRAY:
1. ACUTE TO SUBACUTE COMPRESSION FRACTURE DEFORMITY OF L1 CONFIRMED. APPROXIMATELY 30% LOSS OF ANTERIOR VERTEBRAL BODY HEIGHT.

2. ABDOMINAL AORTIC ANEURYSM AT THE LEVEL OF L3 MEASURING APPROXIMATELY 4 CM

References:

REFERRING PHYSICIAN: BANG NGUYEN, DC

Comments:
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Additional Details:

Case Number: 12339069Last Updated: 05-26-2009
Anatomy: Spine and Peripheral Nervous System   Pathology: Trauma
Modality: Conventional Radiograph, MRAccess Level: Readable by all users

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