CASE STUDY FOR M-1 STUDENTS

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• CASE STUDY FOR M-1 STUDENTS

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CASE 1 Patient presents to his doctor with
complaint of back pain with increasing intensity.
L-2
Diagnosis 1-Degenerative Disc disease at (L2-3
and L4-5)
L-5
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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
Your interpretation here.
  RADIOLOGY EXAM Lateral Lumbar Spine CLINICAL
INDICATION Back pain increasing in
intensity.   REPORT The patient has
degeneration of IV discs at the L2- L3 level and
the L4-L5 level .     CONCLUSION Patient shows
signs of degenerative disc disease affecting L2-3
and L4-5.    
Normal L2 vertebrae
L-2
Disc degeneration at L2-L3 with bone spurs.
L4-5 foramen
Normal L4 vertebrae
L-5
Disc degeneration at L4-L5
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• Three bullet points about pathology identified
• OR
• Management of the identified process
• 50 words or less
• Source of pain is due to inflammation and
  abnormal micromotion instability.
• Many cases can be managed by anti-inflammatory
  medication, physical therapy and bed rest.
• Most common cause of disc degeneration is aging.

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SPINE CASE 2
11 year old male in the trauma room following a
head on collision.
Diagnosis Atlanto-occipital dislocation
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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
  RADIOLOGY EXAM Cross table lateral cervical
spine x-ray. CLINICAL HISTORY 11 yom in trauma
room following a head on collision   REPORT
The space between the skull and C1 is widened
greater than normal. The occipital condyles are
not resting on the superior articular surfaces of
C-1.    CONCLUSION The high impact of the
collision caused disruption of the
Atlanto-occipital joint.    
Cross table lateral
Abnormal curvature of C-Spine
Widened C-1 occipital space
Normal C-5 vert. body
Normal IV foramen
Normal spinous process
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• Three bullet points about pathology
  identified.
• OR
• Management of the identified process
• 50 words or less
• The membranes and ligaments holding the skull
  onto C1 are damaged during this type of injury
  causing the skull to dislocate from the rest of
  the spine.
• An Atlanto-occipital dislocation may occur
  without a fracture of the fracture of the C1
  vertebra.
• Atlanto-occipital dislocations can often be
  fatal, even without a fracture of the c1
  vertebra.

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CASE 3
Patient goes to the doctor with the complaint of
pain and reduced range of motion of his back.
Diagnosis Ankylosing spondylitis
Bamboo Spine
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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
RADIOLOGY EXAM AP and Lateral Lumbar
Spine CLINICAL INDICATION Decresed range of
motion. Chronic lower back pain.   REPORT Fused
vertebral bodies at multiple disc levels.
Scoliosis in the lower thoracic region. Fused
sacroiliac joints.    CONCLUSION The fused
vertebral bodies and fused sacroiliac joints
indicated that the diagnosis is Ankylosing
spondylitis.    
Normal IV disc
Scoliosis
Normal IV foramen
Fused vertebral bodies
Sacrum
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• Three bullet points about the pathology
  OR
• Management of the identified process
• 50 words or less
• Ankylosing spondylitis is a form of arthritis,
  primarily affection the spine
• Most people with AS have a gene that produces the
  genetic marker for the protein HLA-B27
• Can also cause swelling in other areas, such as
  shoulders, hips, ribs, heels and small joints of
  the hands and feet

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20 YEAR OLD MALE WITH BACK PAIN
Diagnosis
Spondylolysis of L-5
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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
Rib
RADIOLOGY EXAM Lateral Lumbar spine
x-ray CLINICAL INDICATION Lower back
pain   REPORT X-ray shows defect indicating a
fracture at the L5 inferior articular process at
the pars interarticularis. The other
zygopophysial joints appear normal.    CONCLUSION
Spondylolysis of the L5 vertebra   
Normal L2 vertebral body
Intervertebral foramen
Pars defect.
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Three bullet points about pathology identified
OR
Management of the identified process
50 words or less May be caused
by failure of the Centrum of L5 to unite
adequately with the neural arches at the
neurocentral joint during development. Bracing ,
Rest and physical therapy are used for the
management of pain
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Patient has back pain and positive lab work up
for proteinuria.
Diagnosis Multiple myeloma
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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
RADIOLOGY EXAM Lateral lumbar spine CLINICAL
INDICATION Back pain and positive labs for
proteinuria.   REPORT Osteoporotic vertebral
bodies in the lumbar spine with bowed
endplates.     CONCLUSION Due to positive lab
workup for proteinuria and areas of osteoporosis
in the spine and vertebra, multiple myeloma has
to be considered.    
Flattened vertebra
Osteoporotic bone
Foramen
Normal bowel gas
Spinous process
Endplate bowing
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• Three bullet points about pathology identified
• OR
• Management of the identified process
• Multiple Myeloma begins when plasma cells become
  abnormal and continue to divide.
• Over time cells collect in bone marrow crowding
  normal blood cells and causing extensive
  destruction to bone leading to osteoporosis.
• Abnormal plasma cells secrete abnormal proteins
  which can lead to clotting and kidney failure.

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80 year old woman goes to the doctor with pain in
her neck. She is currently being treated For
Rheumatoid arthritis
Diagnosis C 1-2 Subluxation
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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
RADIOLOGY EXAM Lateral C-spine X-ray CLINICAL
INDICATION 80 YOF rheumatoid arthritis patient
with neck pain.   REPORT The distance between
the posterior surface of the anterior tubercle of
C-1 and the anterior surface of the dens is
markedly increased indicating that there is
disruption of the transverse ligament of C1 and
C2. There is also degenerative disc narrowing at
C3 through C6.   CONCLUSIONC1-C2
Subluxation Degenerative disc narrowing at C3-C6
   
Note the position of the posterior tubercle of
C-1
Increased distance between the anterior arch of
C1 and the dens
Normal C-6 spinous process
Normal C7 vertebral body
Normal C7-T1 disc space
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• Three bullet points about pathology identified
• OR
• Management of the identified process
• 50 words or less
• C1-C2 subluxation can cause pain in flexion
  because C1 will compress the spinal cord.
• Rheumatoid arthritis can cause stretching and
  destruction of the transverse ligament which
  allows C1 to move forward relative to C2.
• C1-C2 subluxation tends to occur because of
  pannus formation at the gliding synovial joints.

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Case 7 A 75 year old woman goes to the ED
complaining of neck pain. She tells doctor that
she fell down her steps(4) yesterday.
Study the imageadd your diagnosis in the place
provided and send back to Penelope.Al-Emam_at_uscmed.
sc.edu
Diagnosis Fracture of C-2 (Odontoid process)

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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
RADIOLOGY EXAM Lateral C-Spine X-Ray CLINICAL
INDICATION Pain in neck after falling down
steps.   REPORT There appears to be a transverse
fracture at the base of the dens with subsequent
anterior shift of the C1 vertebra and the skull.
The anterior shift in the C1 vertebra indicates a
possible impingement of the spinal cord.
Degenerative disc narrowing is also noted at
C3-4, C4-5 mad C5-6  CONCLUSION There is a
Type ll Fracture of the C2 Odontoid process
causing and anterior shift of the C1 vertebra
indicates a possible impingement of the spinal
canal.    
Fracture of the odontoid
Posterior tubercle of Atlas
Vertebral body of C6
IV disc space
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• Three bullet points about pathology identified
• OR
• Management of the identified process
• 50 words or less
• Non-operative means are contraindicated due to
  the unstable fracture.
• Type II fracture indicated internal fixation as
  the primary management.
• A fusion of the C1 and C2 vertebrae is created
  using wire and midline bone grafting.

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70 year old male is experiencing pain lower
extremity paralysis
Diagnosis Multiple Metastatic Lesions
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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
RADIOLOGY EXAM CT of Thoracic spine CLINICAL
INDICATION Back pain and lower extremity
paralysis   REPORT Red arrows show area of
destructive lesions protruding posteriorly from
the vertebral canal to the spinous
processes.    CONCLUSION Multiple metastatic
lesions are impinging on the nerves and spinal
cord which leads to lower extremity paralysis and
pain experienced by the patient.    
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Three bullet points about pathology identified
OR
Management of the identified process
50 words or less Management of
metastatic lesions could include either radiation
therapy, removal of the tumors through open
surgery or Percutaneous Inage-Guided Vertebral
body Augmentation. Radiation and open surgery
are the two most common treatments. Radiation
offers a non-invasive, less immediate risk
option. Percutaneous Image-Guided Vertebral Body
Augmentation uses bone cement to relieve pain
from spinal tumors and stabilizes the spine. It
is considered less-invasive that open surgery.
Vertebral body
Spinous process of Thoracic vertebra
Rib
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25 year old male with neck pain following MVA
Diagnosis C5 fracture
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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
RADIOLOGY EXAM Lateral C-Spine x-ray CLINICAL
INDICATION Neck pain following MVA   REPORT
Fracture of the anterior portion of the C5
vertebral body. There is widening of facet
joints and interspinous spaces of the C5 cervical
vertebra.    CONCLUSION C5 fracture    
Spinous process
Aligned facet joint
Fragmented anterior portion of vertebral body
Widened facet joint
Trachea
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• Three bullet points about pathology identified
• OR
• Management of the identified process
• 50 words or less
• Fractures of this type are loosely referred to
  as tear-drop fractures based of appearance of
  the triangular displaced vertebral body portion.
• Anterior column trauma may be result of axial
  loading injuries including a combination of
  extreme compression, extension, flexion, or
  rotational events.
• Often, anterior spinal injuries accompany loss
  of motor function, temperature sensation, pain
  but maintaining proprioception.

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SPINE CASE 10 Patient goes to the doctor with
Complaint of back pain.
Please Study the images-add Your diagnosis and
return to me _at_ Penelope.Al-Emam_at_uscmed.sc.edu
Diagnosis--Kypho-scoliosis
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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
RADIOLOGY EXAM AP Lateral Chest. CLINICAL
INDICATION Back pain   REPORT Ap x-ray shows
curvature of the thoracic spine indicative of
scoliosis concave to the left at T-9. Lateral
x-ray shows an exaggerated primary kyphotic curv
of the thoracic spine.    CONCLUSION Kyphotic
scoliosis    
Clavicle
Scoliosis and kyphosis of the thoracic spine
Diaphragm
IV disk space
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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
Three bullet points about pathology identified
OR
Management of the identified process
50 words or less Patient can
undergo surgery for spinal decompression and
spinal fusion with brackets and screws.
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33 year old truck driver goes to the Health
center for his required DOT physical as a new
employee.
Diagnosis Bifid spinous processes C-7, T-1 T-2
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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
RADIOLOGY EXAM Frontal Chest X-ray CLINICAL
INDICATION Required Physical  REPORT Spina
Bifida Occulta in Spinous Processes of C7, T1,
and T2     CONCLUSION see report
    INTERPRETERS NAME_______________ DATE_____
_________
Clavicle
Bifid spinous processes
Normal spinal process
Lt. 4th rib
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• Three bullet points about pathology identified
• OR
• Management of the identified process
• 50 words or less
• Spina bifida occulta occurs when lamina do not
  merge during development, thus creating a bifid
  spinous process.
• Twenty five percent of the population has this
  abnormality, but it is generally asymptomatic.
• The meninges and spinal cord are generally not
  affected due to this defect alone.

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A 50 year old man goes to his general physician
with the complaint of a sore throat x 2
weeks.--- A soft tissue lateral neck x-ray was
done.
Diagnosis Segmentation anomaly of C5/6
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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
RADIOLOGY EXAM Soft tissue lateral
neck CLINICAL INDICATION Sore throat x 2
weeks   REPORT Fusion of vertebral body C5-6
with bony bridge across the disc space.
Transverse and spinous processes appear normal
and healthy. No visible fractures, possible
edema of the anterior soft tissue at level of
C5-C6, no apparent IV disk between C5-C6 mainly
bone present  CONCLUSION Segmentation Anomaly
of C5-C6    
C2 Spinous Process
C3 vertebral body
Hyoid bone
Fused vertebral bodies
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• Three bullet points about pathology identified
• OR
• Management of the identified process
• 50 words or less.
• Congenital
• Defective segmentation of the developing tissue
  within the spine
• Administer anti-inflammatory medication to help
  with sore throat.

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50 year old man falls from a ladder CT
scans done in the emergency room.
Diagnosis Compression fracture of T-12
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Add red arrows captions that confirm the
diagnosis and /or other abnormalities. Use blue
arrows to indicate 3 normal structures .
RADIOLOGY EXAM CT scan of thoracic
spine CLINICAL INDICATION Trauma-Lower back
pain   REPORT Sagittal CT scans reveal decrease
in the height of the vertebral body of T12.
Axial Scans reveal fracture lines in the
vertebral body of T12   CONCLUSION Axial and
sagittal CT scans reveal compression fracture of
the T12 vertebra. Retropulsion of fragments into
the spinal canal is also evident.    
Fracture of T12 vertebral body
Compression fx of T-12
Normal vertebra
Costo-vertebral joint
Facet joint
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• Three bullet points about pathology identified
• OR
• Management of the identified process
• 50 words or less.
• The most common compression fracture occurs in
  the T-12 vertebra.
• The result of a compression fracture is a
  wedge-shaped appearance to the vertebral body.
• A radiographic decrease of 20 or more or a
  decrease in height of the vertebral body by 4mm
  compared with the baseline height confirms
  compression fracture.

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