Infantile vertebral scoliosis

Case contributed by Sonal Desai

Presentation

4 month old boy, ex-full term male with left/right asymmetry on anterior and posterior chest.

Patient Data

Age: 4 month old
Gender: Male
X-ray

1. There are 11 pairs of ribs and 5 lumbar segments. The bone density is normal.

2. Moderate levoconvex thoracolumbar scoliosis with Cobb angle measuring 30 degrees between T5 and L3 vertebral bodies.

3. There is a significant rotary component to the scoliosis with nonvisualization of the right sided pedicles in the lower thoracic vertebral bodies

4. There is concern for hypoplasia of the right half of the vertebral bodies in the lower cervicothoracic spine.

5. Asymmetric configuration of the ribs consequent to scoliosis causes the visual clinical deformity.

6. The heart and central pulmonary vascularity are normal considering technique and spinal curvature.

7. No focal pneumonia, effusion, or pneumothorax.

Case Discussion

This 4-month-old boy, born small for gestational age, at 37 weeks, who presented initially with asymmetry of both left and right aspects of anterior and posterior chest. Confirmed thoracolumbar scoliosis and vertebral anomalies based on plain radiography with Cobb angle measurement of 30 degrees.

This case depicts the need for plain radiographic imaging and prompt evaluation in babies with chest wall asymmetry to aid accurate diagnosis of complex anomalies.

The patient was subsequently referred to pediatric orthopedic clinic for further management.

Infantile scoliosis is diagnosed in children ages 0-3 years. Infantile scoliosis is much rarer than juvenile scoliosis. Infantile and juvenile scoliosis contribute to 10% of all cases of scoliosis.

Infantile scoliosis with vertebral anomalies is seen in association with VACTERL syndrome. Our baby did not manifest any other clinical stigmata to warrant further evaluation. VACTERL association includes:

  • vertebral anomalies
  • anal atresia
  • cardiac defects
  • tracheo-esophageal fistula
  • renal anomalies
  • limb defects

This case was submitted with supervision and input from:

Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center 

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