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Patient Has No Complaints, But Family Is Concerned

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The radiograph shows diffuse osteopenia and spondylosis. Of note is a moderate to severe compression deformity of the T8 vertebral body. However, by plain radiograph, it is age indeterminate as to its acuity. For definitive diagnosis, MRI without contrast is required to assess for marrow edema, which then suggests an acute fracture.

This patient was admitted for further workup. MRI was ultimately obtained and revealed marrow edema within that vertebral body. She was treated with a rigid custom-made brace.

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Nandan R. Hichkad, PA-C, MMSc, practices at the Georgia Neurosurgical Institute in Macon.

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Clinician Reviews - 26(1)
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osteopenia, spondylosis, vertebrae, orthopedics
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Nandan R. Hichkad, PA-C, MMSc, practices at the Georgia Neurosurgical Institute in Macon.

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Nandan R. Hichkad, PA-C, MMSc, practices at the Georgia Neurosurgical Institute in Macon.

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ANSWER
The radiograph shows diffuse osteopenia and spondylosis. Of note is a moderate to severe compression deformity of the T8 vertebral body. However, by plain radiograph, it is age indeterminate as to its acuity. For definitive diagnosis, MRI without contrast is required to assess for marrow edema, which then suggests an acute fracture.

This patient was admitted for further workup. MRI was ultimately obtained and revealed marrow edema within that vertebral body. She was treated with a rigid custom-made brace.

ANSWER
The radiograph shows diffuse osteopenia and spondylosis. Of note is a moderate to severe compression deformity of the T8 vertebral body. However, by plain radiograph, it is age indeterminate as to its acuity. For definitive diagnosis, MRI without contrast is required to assess for marrow edema, which then suggests an acute fracture.

This patient was admitted for further workup. MRI was ultimately obtained and revealed marrow edema within that vertebral body. She was treated with a rigid custom-made brace.

References

References

Issue
Clinician Reviews - 26(1)
Issue
Clinician Reviews - 26(1)
Page Number
13,33
Page Number
13,33
Publications
Publications
Topics
Article Type
Display Headline
Patient Has No Complaints, But Family Is Concerned
Display Headline
Patient Has No Complaints, But Family Is Concerned
Legacy Keywords
osteopenia, spondylosis, vertebrae, orthopedics
Legacy Keywords
osteopenia, spondylosis, vertebrae, orthopedics
Sections
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What is your impression?

An 80-year-old woman presents to the emergency department for evaluation. Her family reports that she has baseline dementia and resides in an assisted living facility. Staff there report that recently the patient has fallen multiple times. The patient herself does not voice any specific complaints, but her family has noticed she is not as active or walking as much as usual. Medical history is significant for mild hypertension. On physical exam, you note that the patient is awake and alert but oriented only to person. Her vital signs are stable. Primary and secondary survey do not demonstrate any obvious injury or trauma. You order some basic blood work, as well as some imaging studies—including thoracic and lumbar radiographs. The lateral thoracic radiograph is shown. What is your impression?
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