Radiological Category Musculoskeletal Principal Modality 1 General Radiography

Radiological Category: Musculoskeletal Principal Modality (1): General Radiography Principal Modality (2): CT Case Report #0079 Submitted by: J. A. Saenz, M. D. Faculty reviewer: Alan Cohen, M. D Date accepted: 13 February 2004

Case History Middle aged male presents to the emergency department following a motor vehicle accident. He was a restrained passenger in a high speed collision with multiple roll-overs. Preliminary review of other primary plain films reveals a femur fracture.

Radiological Presentations

Radiological Presentations

Test Your Diagnosis Which one of the following is your choice for the appropriate diagnosis? After your selection, go to next page. • Bone Tumor • Schmorl’s Node • Vertebral body fracture • Venous Channel

Findings and Differentials Findings: There is a well demarcated, irregular lesion with sclerotic margins in the anterosuperior aspect of L 1 adjacent to the superior end plate. Differentials: • Schmorl’s Node • Infection • Anterior wedge fracture • Neoplasm

Radiological Presentations Well defined sclerotic inferior border

Radiological Presentations

Discussion Clinicians were concerned about an L 1 anterior compression fracture. This lesion was given a preliminary diagnosis of Schmorl’s node after the plain films were reviewed. Given the patients significant mechanism and vital signs a CT of the abdomen and pelvis was ordered and further review of the lesion confirmed the diagnosis. A Schmorl’s node is a protrusion of intervertebral disc material through a break in the subchondral bone plate, with displacement of this material into the vertebral body, leading to an abnormal contour of the spine on radiographs. Schmorl's nodes, which are also termed cartilaginous nodes, may occur in numerous conditions and may result from any disease or condition that leads to weakening of the cartilaginous endplate or subchondral bone of the vertebral body. Radiographically Schmorl's nodes appear as a radiolucent lesion within the vertebral body surrounded by helmet-shaped sclerosis that borders on the intervertebral disc. References: www. amershamhealth. com

Diagnosis L 1 Schmorls’ Node