| Print Date: | May 25, 2013, 9:56 am |
| Title | Absent pedicle in a patient with a lung mass |
| Text | When evaluating a chest radiograph, one should have a search pattern which includes the osseous structures. Absence of one or both of the pedicles at a given vertebral body level is a known but often subtle finding of skeletal metastatic disease which may be evident on a frontal radiograph of the chest performed for unrelated reasons. As opposed to destruction of a pedicle, osteosclerosis of a pedicle may also be present in the setting of metastatic disease (for example, prostate or breast cancer) and is a rare finding in Paget’s diease (2). Algra et al have reported that, when evaluating plain films alone, they report that the most common finding of vertebral metastatic disease is destruction of a pedicle. However, on CT examination, they found the opposite to be true. That is, CT showed the vertebral body to be involved before the pedicles. They concluded that destruction of a pedicle occurs only in combination with and following involvement of the vertebral body (1). Therefore, an absent pedicle represents a relatively late finding in the progression of osseous metastatic disease and usually portends a poorer prognosis. |
| References: | 1. Algra PR, Heimans JJ, Valk J, Nauta JJ, Lachniet M, VanKooten B. Do metastases in vertebrae begin in the body or the pedicles? Imaging study in 45 patients. AJR 1992; 158:1275-1279.
2. Resnick D, Niwayama G. Diagnosis of bone and joint disorders, 2nd ed. WB Saunders (Philadelphia) 1988: 3964-3965. |
| Contributor | Jason Rexroad (Civilian Medical Center) |
| Peer Reviewer | William R Carter, M.D. (National Naval Medical Center Bethesda) |
| Record Number | : 5123 |
| Created | 2003-09-17 00:40:08-04 |
| Modified | 2003-10-16 20:07:33-04 |
| Category: | Neoplasm, carcinoma |
| Location: | Chest, Pulmonary (ex. Heart) |
| Sublocation: | None Selected |
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