Thread by @RyanChristieMD

#WetreadCoW Case 15

Hx: Fall. Back Pain

Professionally appropriate gif responses only please. Extra points for not using the obvious answer. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #MSKRad #NeuroRad

Silly Twitter, lets keep it together now 🤣

ER went ahead and ordered the CT CAP. Does this help?😏

Turns out the patients pain was more T/L junction and L-spine. 🤔

#WetreadCoW Case 15 Answer: Butterfly vertebra

Vertebral anomaly from lack of fusion of the 2 sides of a vertebral segment (?due to persistent notochordal tissue) ➡️ bowtie appearance on frontal or 2 wedges connected at their tips.#FOAMed #FOAMrad #Neurorad #MSKRad #radres

Butterfly Vertebra are generally incidental. Key is to NOT dx as a compression fx.

+corticated borders!
+sup and inf endplates involved
+lat borders normal (post wall ~nl)
+V-shaped endplates➡️bowtie appearance vs U shaped endplates➡️H-shape in Sickle-cell vs uniform ht loss

Butterfly Vert:

CT is tricky (as I tried 😁). Axials➡️butterfly or Pac-man appearance. Since the anterior body never formed➡️kyphosis/gibbus deformity (resembling ant compression fx)so you often get some of the adjacent vertebra on your slice(below). 👀 for symmetry& cortication

Butterfly Vert:

Sags➡️BIG-small-BIG w varying degrees of anterior height - again 👀 symmetry!

If only 1 side present = a hemivertebra➡️lat scoliosis

Typically incidental findings in young adults, but can be assoc w: Alagille syndrome and VACTERL (both above my pay grade 😁)