Vertebral body metastasis

Case contributed by A/Professor Pramit Phal

Presentation

3 months neck pain, left arm pain, numbness. Radiculopathy

Patient Data

Age: 51
Gender: Female
MRI

MRI Cervical spine:

 

A pathological compression fracture involves the C5 vertebral body with approximately 60% central vertebral body height loss, focal kyphosis and bowing of the posterior vertebral cortex (4mm of retropulsion) resulting in moderate canal stenosis and flattening of the anterior aspect of the cord without intrinsic cord signal abnormality. The C5 vertebral body signal is abnormal with low T1 extending to involve the left pedicle, left transverse process and superior articular facet.

Contiguous lobulated soft tissue component extends from the left vertebral body via the left C5/C6 neural exit foramen into left prevertebral soft tissues invading the longus coli muscle and displacing the left vertebral artery anterolaterally out of the foramen transversarium and the left common and internal carotid artery anteriorly. The soft tissue abnormality encircles the left vertebral artery which maintains a patent flow void. Patent flow void is also seen within the left carotid artery. The left C5 paravertebral soft tissue mass measures approximately 22 x 24 x 28 mm (trans x AP x CC). A smaller lobulated soft tissue component is seen at the level of C5 vertebral body on the right.

Both the C5 vertebral body, paravertebral and prevertebral soft tissue enhance vividly.

Extensive subligamentous contrast enhancing soft tissue extending from the level of C1 to T1 deep to the anterior longitudinal ligament.

 

Conclusion:

Severe pathologic crush fracture of the C5 vertebra, with paravertebral and subligamentous T2 hyperintense enhancing soft tissue extending to replaced the vertebral body, with almost complete height loss centrally, resulting in moderate canal stenosis, effacing at the anterior cord, without intrinsic cord signal abnormality.

The process extends into the C5 vertebral left pedicle and articular processes to compress the left neural exit foramina, possibly left C5 and C6 nerve root impingement.

 

 

X-ray

 

There is destruction of the C5 vertebral body, with loss of cortical margins and vertebral height. Associated with prevertebral soft tissue swelling.

 

 

CT

CT-GUIDED CORE BIOPSY OF LEFT NECK MASS

Informed consent. Sterile technique. Lignocaine 1% for local anaesthesia and midazolam and fentanyl for conscious sedation.

Using CT guidance, a 19G co-axial needle was advanced into the left paravertebral neck mass. 20G core biopsy was taken through the co-axial needle with only a small sample of tissue obtained, despite multiple attempts at core biopsy. A small amount of haemoserous fluid was aspirated from the mass (1-2 mL).

Both samples were sent in separate specimen jars to pathology for analysis (histopathology and M, C &; S).

 

 

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Case information

rID: 34469
Case created: 22nd Feb 2015
Last edited: 27th Sep 2015
System: Spine
Inclusion in quiz mode: Included

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