Season 9 Case 16

Hx: Fall. Back Pain

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.

+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