6 Loss of Height of One or More Vertebral Bodies

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig SP 6-1 Severe osteoporosis. (A) Lateral and (B) frontal views of the thoracolumbar spine show striking demineralization and compression of multiple vertebral bodies in a 14½-year-old girl treated with steroids for 5 years for chronic glomerulonephritis. The height age of the girl was only 9 years at this time.6

• Fig SP 6-2 Multiple myeloma. The diffuse myelomatous infiltration causes generalized demineralization of the vertebral bodies and a compression fracture of L2.

• Fig SP 6-3 Tuberculous osteomyelitis of the thoracic spine. (A) Initial film demonstrates vertebral collapse and anterior wedging of adjacent midthoracic vertebrae (arrow). The residual intervertebral disk space can barely be seen. (B) Several months later, there is virtual fusion of the collapsed vertebral bodies, producing a characteristic sharp kyphotic angulation (gibbous deformity).

• Fig SP 6-4 Brucellosis. (A) Frontal plain film of the lower thoracic spine demonstrates loss of height of the T11 and T12 vertebral bodies with destruction of the end plates and swelling of the paravertebral soft tissues (arrows). (B) A lateral tomogram of the lower thoracic spine demonstrates cortical destruction with sclerosis of the inferior end plate of T11 and the superior end plate of T12 (arrows). There is a mild degree of anterior wedging. The overall radiographic appearance is indistinguishable from that of tuberculous spondylitis.

Fig SP 6-5 Fracture. Characteristic anterior wedging of the superior end plate of the L1 vertebral body.

• Fig SP 6-6 Scheuermann's disease. Irregularity of the vertebral end plates and wedging of the vertebral bodies, which causes an arcuate kyphosis.7

• Fig SP 6-7 Langerhans cell histiocytosis. (A) Frontal and (B) lateral views of the spine show complete collapse with flattening of the T12 vertebral body (vertebra plana).

• Fig SP 6-8 Morquio syndrome. Generalized flattening of the vertebral bodies in the (A) cervical and (B) lumbar regions.

• Fig SP 6-9 Spondyloepiphyseal dysplasia. Generalized flattening of the vertebral bodies (platyspondyly).

• Fig SP 6-10 Sickle cell anemia. (A) Biconcave indentations on both the superior and inferior margins of the soft vertebral bodies produce the characteristic “fish vertebrae.” (B) Localized step-like central depressions of multiple vertebral end plates.

• Fig SP 6-11 Osteogenesis imperfecta. Generalized flattening of vertebral bodies associated with fractures of multiple ribs and long bones in an infant.