Post on 05-Jan-2016
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THORACIC & LUMBAR NORMAL VARIANTS
NORMAL RADIOGRAPHIC ANATOMY 1
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"I am enough of an artist to draw freely upon my imagination. Imagination is more important than knowledge. Knowledge is limited. Imagination encircles the world."
- Albert Einstein
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SPINA BIFIDA OCCULTA C/B single or
multiple M/B a clean smooth
line or asymmetric C/B at any level Occurs M/C at L5 &
S1 , M/C males 9:1
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RIB ANOMALIES M/C anomaly of the ribs is anterior
bifurcation Rib synostosis is seen posteriorly, and
may involve two or more ribs– may be a contributor to Congenital
Structural Scoliosis Hypoplastic, aplastic, asymmetric,
especially at T12
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Pectus Excavatum: Y&R p 240
M/C deformity of the thoracic wall Also known as funnel chest Posterior displacement of the sternum on lat On the frontal projection the inferior
angulation of the anterior ribs may be excessively accentuated.
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Injection Granuloma (Depot)
Y&R p 1413
Cystic Calc. seen at site of musc. injections M/C within the posterior lateral buttocks Represents fat necrosis w/ subsequent calc. Seen w/ cortical steroid therapy Used w/ inflammatory processes such as
SLE or RA Long term steroid use may lead to excessive
bone demineralization (& AVN).
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Phleboliths: Y&R p 1318
Concretions, representing calc. of thrombi attached to the walls of veins.
Most frequently seen within the pelvic basin below the ischial spines.
The significance of phleboliths is undefined.
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HAHN’S VENOUS CLEFTS Venous channels Transverse, short lucent
line in the mid portion of the VD
M/C in lower thoracic spine
May appear to disrupt posterior VB margin
May be single or multiple
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SCHMORL’S NODE
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NOTOCHORDAL IMPRESSION
Nuclear Impression Smooth undulating
cortical surface Seen on the AP as a
double hump or “Cupids Bow Contour”
May be superior or inferior endplate
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CUPID’S BOW CONTOUR
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BUTTERFLY VERTEBRAE Mid VB Cleft Usually symmetrical Hour glass shape Both pedicles present VB above & below will
match contour M/C T & L spine M/B multiple Other anomalies….
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LIMBUS BONE Small Triangular
ossicle Superior or Inferior Anterior or Posterior Nucleus herniation,
diagonal Schmorl’s node
May cause mass effect posteriorly
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HEMIVERTEBRAE Only one lateral
ossification center appears
Triangular shaped VB tapering to a point, resulting in a wedge
Generally multiple May be fused or
separate Disc may be normal
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HEMIVERTEBRAE Cont’d
May have one on either side that nullifies or corrects any lateral convexity
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KNIFE-CLASP DEFORMITY
SBO of S1 with the ossification center of S1 joined with L5 SP
Elongated SP extends inferiorly over cleft
Increase ROM, SP may actually impinge on canal contents on extreme extension
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TRANSITIONAL SEGMENT Can occur at any
region of transition L/S is most common May be Sacralization
or Lumbarization Spatulation of TP’s,
unilateral or bilateral, may have pseudo-articulations
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CONG. PEDICLE ABSENCE
Contralateral pedicle will show sclerotic changes
Must DDX from a destructive process such as mets or Neurofibromatosis which will not show sclerotic changes of the opposite pedicle
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OPPENHEIMER’S OSSICLE Non union of the tip
of the inferior articular process
M/C in the Lumbar M/B Unilateral or Bi Persistent nonunion of
the inferior articular processes
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FACET TROPISM Asymmetry of the
facet articulation from side to side
One joint space visible, the joint contralaterally not
M/C at L5/S1
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PARAGLENOID SULCI
Transmits the superior branch of the gluteal artery & supplies insertion for SI lig.
Rare in males M/C bilateral
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IT IS TIME TO PLAY
NAME THAT ANOMALY
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That Ends RoundOne:
BONUS ROUND
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Artifacts
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Axillary Surgical Clips
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Implants
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Pacemaker
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Bee in Cassette
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Cholecystectomy
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Hand over Lumbar
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Bra Fetal Head
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Tubal Ligation
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IUD
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Motion
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Dried cracked emulsion
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Mule
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Penile implant
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Likes to eat pins
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Major Body Work
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Static, Tree Type
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Underwear Line
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Vasectomy
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Diaphragm
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THANK YOU FOR THANK YOU FOR PLAYINGPLAYING
NAME THAT NAME THAT ANOMALYANOMALY