Persistent ossiculum terminale
Elderly man with neck pain and tenderness post fall.
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Well-corticated bony fragment superior to the dens most likely represents a persistent ossiculum terminale.
Multilevel degenerative disease most severe at C5/6 and C6/7 with loss of intervertebral disc space height and partial fusion of C6 and C7 vertebral bodies. Minimal anterolisthesis C4 on C5 is almost certainly a result. Anterolateral osteophytes from C3-C7 with multiple lucencies that appear well corticated and are not acute fractures. Moderate facet joint arthropathy. Rounded lucency in the right C5 articular process has a slightly unusual appearance that may reflect a subchondral cyst/geode or an haemangioma, although more aggressive lesions cannot be excluded on this study.
No acute cervical spine fracture or malalignment demonstrated. Prevertebral soft tissues are within normal limits.
4 case question available
The differential diagnosis of a persistent ossiculum terminale, which is a normal variant, includes:
- os odontoideum (larger)
- dens fracture (irregular, non-corticated edges)