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CT T-Spine Compression fx

TECHNIQUE: Thin section helical scans were obtained from the superior endplate of T1 to the inferior endplate of T12 without contrast. The image set was reformatted in sagittal and coronal plane.

Findings: There is mild impaction and anterior wedging of the superior endplate of the T12 vertebral body. There is no retropulsed fragment. The posterior portion of the vertebral body is normal. Central depression in the vertebral body may represent a Schmorl's node or more acute injury. The anterior height of the vertebral body is 20 mm, the posterior height of the vertebral body is 29 mm. The remaining visualized spine is unremarkable.
The soft tissues are notable for a right lower lobe calcified nodule measuring 7 mm and punctate calcifications in the spleen, compatible with old granulomatous disease.

Impression: Compression of the anterior superior endplate of T12 without retropulsed fragment. Given the clinical presentation this is consistent with an acute fracture.
Vertebral bony structures: There is near-complete collapse of the T8 vertebral body with neural foraminal and mild spinal canal narrowing secondary to retropulsed fragments at this level. There is cortical discontinuity at the anterior aspect of the superior endplate of T9 suggestive of superior endplate compression fracture. There is diffuse loss of the cortical trabecular throughout the vertebral bodies which may be consistent with patient's history of osteoporosis; however, this can also be seen as a result of multiple myeloma.
Diffuse endplate osteophytosis, and facet arthropathy is demonstrated with relative sparing of the superior thoracic spine, most prominent at T9-T10. The remainder of the vertebral body heights and disc spaces are preserved.

Alignment: There is accentuation of the normal thoracic kyphosis secondary to compression fractures.

Demonstrated Paraspinal Soft Tissues: Diffuse calcification is seen throughout the visualized portions of the thoracic aorta which is consistent with atherosclerotic disease. There is a large right-sided soft tissue density paraspinal mass at the T8-T9 level which appears to be contiguous with the vertebral body destructive process and adjacent lung parenchymal. Large right greater than left bilateral pleural effusions are again visualized.

IMPRESSION: T8 worst than T9 pathologic compression fractures with minimal spinal canal stenosis as described above, and paraspinal soft tissue abnormality at the T8-T9 with right greater than left bilateral pleural effusions. Etiologies include infectious or neoplastic (including multiple myeloma); less likely osteoporotic processes. Recommend clinical correlation with laboratory values.