Sandwich vertebral body - osteopetrosis

Case contributed by Dr Bruno Di Muzio


HIV positive patient with lymphoma.

Patient Data

Age: 35 years
Gender: Male

Abdomen X-ray

Signals of hepatosplenomegaly. Vertebral bodies show bandlike regions of increased opacity at its superior and inferior margins. 


CT Abdomen and pelvis (selected images)

The CT study shows sharply demarcated sclerotic bands on the inferior and superior endplates of all vertebral bodies (alternating dense-lucent-dense appearance) that represents accumulations of excess osteoid.

Case Discussion

The dense bands involving both endplates of the vertebral bodies are sharply demarcated (sandwich appearance) and are associated with other sclerotic bone foci in the pelvic bones, which have the bone within a bone appearance

Although at the time of this scan there was a recent diagnosis of lymphoma, the hepatosplenomegaly could be attributed to extramedullary hematopoiesis due to bone red marrow replacement, in the setting of the aforementioned bone changes. 

The features are suggestive of osteopetrosis, likely the autosomal dominant form.  

This case was initially interpreted as a rugger jersey spine, which would be an imaging differential in the right clinical scenario, but the patient had normal renal function and no evidence of hyperparathyroidism.

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Case information

rID: 20319
Published: 19th Jan 2015
Last edited: 9th Aug 2018
Tag: spine
Inclusion in quiz mode: Included

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