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Bone single-photon emission computed tomography and three-dimensional computed tomography in the diagnosis of low costal variation and pathologies.

Silov G, Erdoğan Z, Özdal A, Özaşlamacı A - Indian J Nucl Med (2015 Apr-Jun)

Bottom Line: In general, there are five lumbar vertebras in normal human subjects.But occasionally there are six.In such a situation, a radiologist need to discern between lumbarization of S1 (S1 vertebra becomes segmented and mimics L5) or due to hypoplastic 12(th) ribs, hence the T12 vertebra is wrongly assumed to be L1.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey.

ABSTRACT
In general, there are five lumbar vertebras in normal human subjects. But occasionally there are six. In such a situation, a radiologist need to discern between lumbarization of S1 (S1 vertebra becomes segmented and mimics L5) or due to hypoplastic 12(th) ribs, hence the T12 vertebra is wrongly assumed to be L1. These interesting images serve a multimodality approach to right aplasia/left hypoplasia of 12(th) rib, injury of left 11(th) rib and subluxation of left 11(th) Costovertebral joint in a patient with lumbar back pain.

No MeSH data available.


Related in: MedlinePlus

On the three-dimensional computed tomography imaging, left 12th hypoplastic rib (arrow) was observed while right one was not. Also left 11th costovertebral joint was subluxated
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Figure 3: On the three-dimensional computed tomography imaging, left 12th hypoplastic rib (arrow) was observed while right one was not. Also left 11th costovertebral joint was subluxated

Mentions: The patient with intense low back pain was also further investigated with three phase bone scintigraphy (TPBS), whole body bone scintigraphy (WBBS) and thoracolumbar bone single-photon emission computed tomography (SPECT). There were no abnormal findings on the first two phase of TPBS. On the WBBS, there were not seen the ribs of 12th and moderate diffuse activity involvement was observed on the left 11th rib [Figure 2a]. In the coronal SPECT images, there was diffuse increased uptake in the left 11th rib [Figure 2b]. On the three-dimensional-CT imaging, left 12th hypoplastic rib was observed while right one was not. Also left 11th Costovertebral joint was subluxated [Figure 3]. Ribs 11 and 12 do not attach to an anterior costal cartilage or transverse process, but rather invest into the fascia and musculature of the lateral and posterior abdominal wall. Ribs 11 and 12 are described as having caliper motion, primarily influenced by their relationship to their muscular attachments. The caliper motion of ribs eleven and twelve can be seen to be related to the near-vertical orientation of the small transverse processes of T11 and T12 as well as the way the ribs invest into the abdominal musculature, thoracolumbar fascia, and diaphragm. Another important lower extremity muscle affecting rib cage motion is the quadrates lumborum, which originates from the iliolumbar ligament and the posterior part of the iliac crest, runs along the posterior lateral aspect of the vertebral column, and inserts on the transverse processes of the upper four lumbar vertebra and the inferior aspect of the 12th rib on each side.[7] According to all of these findings, repetitive daily minor posttraumatic subluxation of the left 11th rib and injury was diagnosed in this patient.


Bone single-photon emission computed tomography and three-dimensional computed tomography in the diagnosis of low costal variation and pathologies.

Silov G, Erdoğan Z, Özdal A, Özaşlamacı A - Indian J Nucl Med (2015 Apr-Jun)

On the three-dimensional computed tomography imaging, left 12th hypoplastic rib (arrow) was observed while right one was not. Also left 11th costovertebral joint was subluxated
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4379687&req=5

Figure 3: On the three-dimensional computed tomography imaging, left 12th hypoplastic rib (arrow) was observed while right one was not. Also left 11th costovertebral joint was subluxated
Mentions: The patient with intense low back pain was also further investigated with three phase bone scintigraphy (TPBS), whole body bone scintigraphy (WBBS) and thoracolumbar bone single-photon emission computed tomography (SPECT). There were no abnormal findings on the first two phase of TPBS. On the WBBS, there were not seen the ribs of 12th and moderate diffuse activity involvement was observed on the left 11th rib [Figure 2a]. In the coronal SPECT images, there was diffuse increased uptake in the left 11th rib [Figure 2b]. On the three-dimensional-CT imaging, left 12th hypoplastic rib was observed while right one was not. Also left 11th Costovertebral joint was subluxated [Figure 3]. Ribs 11 and 12 do not attach to an anterior costal cartilage or transverse process, but rather invest into the fascia and musculature of the lateral and posterior abdominal wall. Ribs 11 and 12 are described as having caliper motion, primarily influenced by their relationship to their muscular attachments. The caliper motion of ribs eleven and twelve can be seen to be related to the near-vertical orientation of the small transverse processes of T11 and T12 as well as the way the ribs invest into the abdominal musculature, thoracolumbar fascia, and diaphragm. Another important lower extremity muscle affecting rib cage motion is the quadrates lumborum, which originates from the iliolumbar ligament and the posterior part of the iliac crest, runs along the posterior lateral aspect of the vertebral column, and inserts on the transverse processes of the upper four lumbar vertebra and the inferior aspect of the 12th rib on each side.[7] According to all of these findings, repetitive daily minor posttraumatic subluxation of the left 11th rib and injury was diagnosed in this patient.

Bottom Line: In general, there are five lumbar vertebras in normal human subjects.But occasionally there are six.In such a situation, a radiologist need to discern between lumbarization of S1 (S1 vertebra becomes segmented and mimics L5) or due to hypoplastic 12(th) ribs, hence the T12 vertebra is wrongly assumed to be L1.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey.

ABSTRACT
In general, there are five lumbar vertebras in normal human subjects. But occasionally there are six. In such a situation, a radiologist need to discern between lumbarization of S1 (S1 vertebra becomes segmented and mimics L5) or due to hypoplastic 12(th) ribs, hence the T12 vertebra is wrongly assumed to be L1. These interesting images serve a multimodality approach to right aplasia/left hypoplasia of 12(th) rib, injury of left 11(th) rib and subluxation of left 11(th) Costovertebral joint in a patient with lumbar back pain.

No MeSH data available.


Related in: MedlinePlus