Persistent ossiculum terminale

Case contributed by Dr Henry Knipe

Presentation

Elderly man with neck pain and tenderness post fall.

Patient Data

Age: 78
Gender: Male
Modality: CT

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. 

Case Discussion

The differential diagnosis of a persistent ossiculum terminale, which is a normal variant, includes:

  • os odontoideum (larger)
  • dens fracture (irregular, non-corticated edges) 
PlayAdd to Share

Case Information

rID: 25744
Case created: 6th Nov 2013
Last edited: 5th Sep 2015
Tag: spine
Inclusion in quiz mode: Excluded

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.