Plain Films

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Plain Films
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Back Pain
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Bamboo Spine Sign

• Ankylosing spondylitis
• Anterior and lateral radiograph of the lumbar
  spine which reveals near complete fusion of all
  of the vertebral bodies. Spinal changes which
  include squaring of the vertebral bodies and
  fusion between adjacent levels. The fusion is
  secondary to syndesmophytes and resembles a
  bamboo stalk. This is most commonly found in
  ankylosing spondylitis.

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Back Pain
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Dagger Sign

• Ankylosing Spondylitis
• Syndesmophytes bridge the disc spaces
• In addition, there is a linear increased density
  running along the spinous processes. The dagger
  sign is a single central radiodense line on
  frontal radiographs related to ossification of
  interspinous ligaments.

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No hx
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Bone in Bone Sign

• Osteopetrosis
• Single lateral lumbar spinal x-ray revealing
  increased sclerosis in the superior and inferior
  portions of the midbody of the vertebra. This is
  seen in vertebrae that have a small replica of
  the vertebral body inside the normal one, giving
  a bone-in-bone sign. It is produced by failure of
  osteoclastic activity causing abnormally dense
  bone that occurs intermittently producing zones
  of abnormal density alternating with relatively
  more normal bone. This is a characteristic
  finding seen in osteopetrosis.

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Bone in Bone Sign

• Indicates Bone Recovery
• DDX includes severe systemic illness, heavy metal
  intoxication, radiation tx thorotrast
  classically osteopetrosis

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NF1

• Lateral Thoracic Meningocele

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No Hx Different Patients
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Hair on End Sign

• Hemolytic anemia
• Two lateral skull x-rays with thin, fine linear
  extensions radiating out from the skull,
  appearing as hair standing 'on-end' from the
  skull. The hair represents the accentuated
  trabeculae extending between the inner and outer
  skull tables in the expanded diploic marrow
  spaces. It appears to be on end because the
  trabeculae are oriented perpendicular to the
  inner and outer tables of the skull. Top Sickle
  cell disease. Bottom Thalassemia.

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Back Pain
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Intravertebral Vacuum Cleft Sign

• Avascular Necrosis
• Horizontally oriented linear area of lucency
  within the body of a single collapsed vertebral
  body. The intravertebral vacuum cleft sign is a
  gas-density cleft within a vertebral body,
  secondary to local bony ischemic necrosis with
  nonhealing vertebral collapse. This ischemic
  vertebral fracture is not known to occur
  secondary to inflammation or neoplastic causes.

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Back Pain
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Back Pain
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Back Pain
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Inverted Napoleon Hat Sign

• Spondylolisthesis L5
• Frontal and lateral radiographs of the lumbar
  spine revealing anterolisthesis of the L5
  vertebral body with the typical inverted Napoleon
  Hat sign. This sign is reserved for
  spondylolisthesis of the L5 vertebral body. With
  a case of spondylolisthesis, the AP radiograph
  will reveal the anterior border of the transverse
  process in continuity with the anterior border of
  the body of the same vertebrae. This continuous
  anterior border of the L5 vertebrae will be
  projected against the shadow of the sacrum, and
  appear as an upside-down (or inverted) Napoleon
  hat.

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Trauma
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Orbit Teardrop Sign

• Blowout fracture
• The floor of the orbit is the most common portion
  of the orbit to sustain fracture. A classic
  radiographic finding in blow-out fractures is the
  presence of a polypoid mass (the tear-drop)
  protruding from the floor of the orbit into the
  maxillary antrum The tear-drop represents the
  herniated orbital contents, periorbital fat and
  inferior rectus muscle.

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Post traumatic bone cyst

• Two sets of frontal and lateral radiographs,
  separated only by time, which reveal the
  "tumbling bullet sign"--which is simply a bullet
  which changes its location and orientation within
  a solitary bone cyst. This sign serves two
  purposes. It is documentation of the evolution of
  a solitary bone cyst as a corollary of trauma,
  and reveals the free movement of the foreign body
  within the confines of the lesion establishing
  its cystic rather than solid nature. It is
  similar to the fallen fragment sign.

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L5 Pars Defect
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Chronic renal failure

• Roentgenographic appearance of increased density
  in the upper and lower zones of the vertebral
  body in a striated appearance. The pattern was
  similar to the alternating colors of the rugby
  players jersey design popular at the time of the
  description of this entity. Rugger Jersey spine
  is typically reserved for secondary
  hyperparathyroidism.

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Met from Breast Ca

• A uniformly white vertebra with no abnormality of
  its contour or adjacent disks. The vertebra
  stands out against the adjacent normal, or
  darker, vertebral bodies. While the list of
  possible etiologies of ivory vertebrae is
  extensive, the most common causes of ivory
  vertebrae are typically metastatic disease, and
  Pagets, Lymphoma

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• Smooth retropharyngeal mass with anterior
  displacement of hypopharynx

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DDX

• Retropharyngeal abscess
• Retropharyngeal hematoma
• Rhabdomyosarcoma
• Lymphadenopathy (only the suprahyoid RPS contains
  nodes)
• Lymphoma

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Retropharyngeal abscess

• Typically due to extension of a suppurative
  bacterial lymphadenitis
• Most commonly Staph aureus, Strep B, oral flora
• Age usually less than 1 yr
• Clinical fever, stiff neck, dysphagia

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• Most cases present with cellulitis rather than
  true abscess
• Other causes include foreign body perforation and
  trauma
• Tx IV antibiotics and drainage

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NF1 Lambdoid Suture Defect
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• NF1 - neurofibroma

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• Sturge-Weber

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• Hangmans Fx

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• Bilateral Locked Facets

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• Depressed Skull Fx

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• MM

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• Lateral radiographs of the spine reveals central
  endplate depression with sparing of the anterior
  and posterior margins of the endplate. Several
  current names have been ascribed to these same
  changes seen in patients with hemoglobinopathy,
  such as Lincoln Log Sign, or H-shaped vertebra.
  Although not pathognomonic, these terms are
  typically reserved for a patient with Sickle-Cell
  disease.

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• Discitis/Osteo

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Choroid plexus Calc
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Marked OPL