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Age: 54

Sex: Male

Indication: Trauma, right C7 transverse process and articular pillar fractures on prior CT

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Case #10


Findings

  • Known acute fractures involving the right C7 transverse process and articular pillars are not well demonstrated on this study
  • T2/STIR signal hyperintensity throughout the cervical and visualized upper thoracic interspinous ligaments
  • T2/STIR signal hyperintensity in the facet joints on the right at C3-C4, C5-C6, and C6-C7 and on the left at C4-C5
  • T2/STIR signal hyperintensity in the C6-C7 and C7-T1 intervertebral discs
  • Focal disruptions of the anterior longitudinal ligament at C4-C5, C5-C6, C6-C7, and C7-T1
  • Likely partial disruption of the posterior longitudinal ligament at the level of C7
  • Stripping and fragmentation of the supraspinous ligament from C6-T4
  • T2/STIR hyperintense and mildly T1 hyperintense ventral epidural collection extending from C6-C7 through T1-T2 measuring up to 4 mm in thickness with resultant mild spinal canal stenosis
  • Prevertebral thickening and T2/STIR signal hyperintensity extending throughout the cervical and upper thoracic spine, most pronounced from C1-C4
  • Extensive contusion/hematoma in the posterior paraspinal soft tissues of the lower neck and upper back
  • Multilevel small posterior disc osteophyte complexes and uncovertebral hypertrophy contribute to moderate left neural foraminal stenosis at C3-C4 and otherwise mild multilevel spinal canal and neural foraminal stenosis


Diagnosis

  • Ligamentous injury and epidural hematoma

Sample Report

Known acute fractures involving the right C7 transverse process and articular pillars are not well demonstrated on this study. No additional areas of marrow edema to suggest additional fracture occult by CT.

Extensive ligamentous injury in the cervical and upper thoracic spine, including focal disruptions of the anterior longitudinal ligament at C4-C5, C5-C6, C6-C7, and C7-T1, likely partial disruption of the posterior longitudinal ligament at the level of C7, interspinous ligament injury throughout the cervical and visualized upper thoracic interspinous ligaments, and stripping and fragmentation of the supraspinous ligament from C6-T4. T2/STIR signal hyperintensity in the facet joints on the right at C3-C4, C5-C6, and C6-C7 and on the left at C4-C5 may relate to degenerative change or facet capsular injury. Edema in the intervertebral discs at C6-C7 and C7-T1 concerning for disc injuries.

Ventral epidural hematoma extending from C6-C7 through T1-T2 measuring up to 4 mm in thickness with resultant mild spinal canal stenosis.

Prevertebral edema extending throughout the cervical and upper thoracic spine, most pronounced from C1-C4. Extensive contusion/hematoma in the posterior paraspinal soft tissues of the lower neck and upper back.


Discussion

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Images

Focal disruption of the anterior longitudinal ligament at multiple levels (red arrows) and ventral epidural hematoma (yellow arrows), best shown on this sagittal STIR sequence.



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