1 THORACIC & LUMBAR NORMAL VARIANTS NORMAL RADIOGRAPHIC ANATOMY 1

2 "I am enough of an artist to draw freely upon my imagination. Imagination is more important than knowledge. Knowledge is limited. Imagination encircles the world." - Albert Einstein

3 SPINA BIFIDA OCCULTA u C/B single or multiple u M/B a clean smooth line or asymmetric u C/B at any level u Occurs M/C at L5 & S1, M/C males 9:1

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6 RIB ANOMALIES u M/C anomaly of the ribs is anterior bifurcation u Rib synostosis is seen posteriorly, and may involve two or more ribs –may be a contributor to Congenital Structural Scoliosis u Hypoplastic, aplastic, asymmetric, especially at T12

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10 Pectus Excavatum: Y&R p 240 u M/C deformity of the thoracic wall u Also known as funnel chest u Posterior displacement of the sternum on lat u On the frontal projection the inferior angulation of the anterior ribs may be excessively accentuated.

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12 Injection Granuloma (Depot) u Y&R p 1413 u Cystic Calc. seen at site of musc. injections u M/C within the posterior lateral buttocks u Represents fat necrosis w/ subsequent calc. u Seen w/ cortical steroid therapy u Used w/ inflammatory processes such as SLE or RA u Long term steroid use may lead to excessive bone demineralization (& AVN).

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14 Phleboliths: Y&R p 1318 u Concretions, representing calc. of thrombi attached to the walls of veins. u Most frequently seen within the pelvic basin below the ischial spines. u The significance of phleboliths is undefined.

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16 HAHN’S VENOUS CLEFTS u Venous channels u Transverse, short lucent line in the mid portion of the VD u M/C in lower thoracic spine u May appear to disrupt posterior VB margin u May be single or multiple

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18 SCHMORL’S NODE

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23 NOTOCHORDAL IMPRESSION u Nuclear Impression u Smooth undulating cortical surface u Seen on the AP as a double hump or “Cupids Bow Contour” u May be superior or inferior endplate

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26 CUPID’S BOW CONTOUR

27 BUTTERFLY VERTEBRAE u Mid VB Cleft u Usually symmetrical u Hour glass shape u Both pedicles present u VB above & below will match contour u M/C T & L spine u M/B multiple u Other anomalies….

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30 LIMBUS BONE u Small Triangular ossicle u Superior or Inferior u Anterior or Posterior u Nucleus herniation, diagonal Schmorl’s node u May cause mass effect posteriorly

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33 HEMIVERTEBRAE u Only one lateral ossification center appears u Triangular shaped VB tapering to a point, resulting in a wedge u Generally multiple u May be fused or separate u Disc may be normal

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36 HEMIVERTEBRAE Cont’d u May have one on either side that nullifies or corrects any lateral convexity

37 KNIFE-CLASP DEFORMITY u SBO of S1 with the ossification center of S1 joined with L5 SP u Elongated SP extends inferiorly over cleft u Increase ROM, SP may actually impinge on canal contents on extreme extension

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40 TRANSITIONAL SEGMENT u Can occur at any region of transition u L/S is most common u May be Sacralization or Lumbarization u Spatulation of TP’s, unilateral or bilateral, may have pseudo-articulations

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43 CONG. PEDICLE ABSENCE u Contralateral pedicle will show sclerotic changes u Must DDX from a destructive process such as mets or Neurofibromatosis which will not show sclerotic changes of the opposite pedicle

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48 OPPENHEIMER’S OSSICLE u Non union of the tip of the inferior articular process u M/C in the Lumbar u M/B Unilateral or Bi u Persistent nonunion of the inferior articular processes

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51 FACET TROPISM u Asymmetry of the facet articulation from side to side u One joint space visible, the joint contralaterally not u M/C at L5/S1

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54 PARAGLENOID SULCI u Transmits the superior branch of the gluteal artery & supplies insertion for SI lig. u Rare in males u M/C bilateral

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62 IT IS TIME TO PLAY NAME THAT ANOMALY

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103 That Ends Round One: BONUS ROUND

104 u Artifacts

105 u Axillary Surgical Clips

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107 u Implants

108 u Pacemaker

109 u Bee in Cassette

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112 u Cholecystectomy

113 u Hand over Lumbar

114 u Bra u Fetal Head

115 u Tubal Ligation

116 u IUD

117 u Motion

118 u Dried cracked emulsion

119 u Mule

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121 u Penile implant

122 u Likes to eat pins

123 u Major Body Work

124 u Static, Tree Type

125 u Underwear Line

126 u Vasectomy

127 u Diaphragm

128 THANK YOU FOR PLAYING NAME THAT ANOMALY