Season 9 Case 16
Hx: Fall. Back Pain
ER went ahead and ordered the CT CAP. Does this help?
Turns out the patients pain was more T/L junction and L-spine.
Answer: Butterfly vertebra
Vertebral anomaly from lack of fusion of the 2 sides of a vertebral segment (?due to persistent notochordal tissue) -> bowtie appearance on frontal or 2 wedges connected at their tips.
Butterfly Vertebra are generally incidental. Key is to NOT dx as a compression fx.
+sup and inf endplates involved
+lat borders normal (post wall ~nl)
+V-shaped endplates -> bowtie appearance vs U shaped endplates which -> "H-shape" in Sickle-cell vs uniform ht loss
CT is tricky. Axials show butterfly or Pac-man appearance. Since the anterior body never formed. This yields kyphosis/gibbus deformity (resembling ant compression fx)so you often get some of the adjacent vertebra on your slice(below).
Look for symmetry & cortication!
Sagitals show BIG-small-BIG w varying degrees of anterior height - again look for symmetry!
If only 1 side present = a hemivertebra -> lat scoliosis
Typically incidental findings in young adults, but can be assoc w: Alagille syndrome and VACTERL