|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 Pagetâ€™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|
|Location:||Chest, Pulmonary (ex. Heart)|
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