Season 9 Case 16

Season 9 Jan 31, 2021

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.

+corticated borders!

+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

Butterfly Vert:

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



Professor of the Darkroom Arts

Great! You've successfully subscribed.
Great! Next, complete checkout for full access.
Welcome back! You've successfully signed in.
Success! Your account is fully activated, you now have access to all content.