Presentation
Newly diagnosed breast cancer. Back pain.
Patient Data
Multiple enhancing vertebral lesions are visible, consistent with breast cancer metastases. T12 and L2 vertebral bodies are massively infiltrated with the involvement of the pedicles, which appear expanded, and L2 posterior elements. A severe compression fracture of T12 vertebral body is seen, with fluid sign and posterior bulging of the posterior cortex of the vertebral body, subsequent compression of the anterior thecal sac and abutment of the left spinal nerve root T12. There is also a mild fracture of the inferior vertebral plate of L2. No mass effect on the distal spinal cord.
Case Discussion
Breast cancer is one of the most common types of neoplasm causing vertebral metastases. The infiltrated vertebrae are prone to pathological fractures. Although there is fluid sign present in the T12 collapsed vertebral body, which is rather typical for osteoporotic fractures, other features like bone marrow replacement with involvement of the pedicles, posterior cortex bulging and other vertebral metastases strongly favour a pathological vertebral fracture.
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