Case of the Week 93Case of the Week 93

This 62 year old male presented to the This 62 year old male presented to the practice of Carole Beetschen, DC, practice of Carole Beetschen, DC,

Genève, Switzerland with an insidious Genève, Switzerland with an insidious onset of increasing neck pain. After onset of increasing neck pain. After the history (stomach cancer in 2005 the history (stomach cancer in 2005

with ablation and chemotherapy. Liver with ablation and chemotherapy. Liver mets in 2008) and examination (no mets in 2008) and examination (no

neurological deficits. Stiff neck, neurological deficits. Stiff neck, especially in lat flexion) she referred especially in lat flexion) she referred

him for the following test.him for the following test.

Coronal Bone Window CT slice through the bodies of the Coronal Bone Window CT slice through the bodies of the cervical spine. What is abnormal? What is the likely cervical spine. What is abnormal? What is the likely

diagnosis or DDX? (See next slide)diagnosis or DDX? (See next slide)

Additional soft tissue window CT slices for this Additional soft tissue window CT slices for this patientpatient

AnswersAnswers Abnormal CT findingsAbnormal CT findings

Lytic destruction of the Lytic destruction of the posterior and right side of posterior and right side of the body of C3 is noted the body of C3 is noted with cortical destruction with cortical destruction and partial collapse.and partial collapse.

The right vertebral artery is The right vertebral artery is displaced laterally by a soft displaced laterally by a soft tissue mass.tissue mass.

Differential DiagnosisDifferential Diagnosis The most likely diagnosis The most likely diagnosis

at this age must always be at this age must always be lytic metastatic disease. lytic metastatic disease. Multiple Myeloma is a good Multiple Myeloma is a good differential diagnosis. differential diagnosis.

Same patient 2 ½ months laterSame patient 2 ½ months later

Notice the further pathological collapse of C3, extending into the spinal canal. This was a proven case of Lytic Metastasis.

The same 62 year old male also has a history of The same 62 year old male also has a history of LBP. (The patient has the right to more than one LBP. (The patient has the right to more than one

condition.) What is the diagnosis?condition.) What is the diagnosis?

Mid sagittal CT slice Parasagittal slice

AnswerAnswer Diagnosis:Diagnosis:

Spondylolytic Spondylolytic spondylolisthesis L5 spondylolisthesis L5 with marked with marked degenerative disc degenerative disc disease. The pars disease. The pars defect on one side is defect on one side is nicely seen on the nicely seen on the parasagittal slice.parasagittal slice.

Limbus bone anterior Limbus bone anterior superior L4.superior L4.

What would the imaging findings of What would the imaging findings of the C3 vertebra looked like on the C3 vertebra looked like on

MRI?MRI?Low signal intensity on T1 weighted Low signal intensity on T1 weighted

imagesimagesHigh signal intensity on T2 and STIR (fat High signal intensity on T2 and STIR (fat

suppressed) weighted images.suppressed) weighted images.