Case 29 - Transverse process fracture

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

History: Trauma- 51YOF in MVC, L shoulder/chest wall tenderness, L clavicle tenderness, LLQ tenderness, R knee through ankle tenderness and L tib/fib tenderness

Technique: Axial CT scan images were performed from the foramen magnum to the vertex without administration of intravenous contrast. Multiplanar reformats were performed. The cervical spine was imaged with axial scans and multiplanar reconstructions in sagittal and coronal planes.

Findings:

Brain: There is no evidence of intracranial hemorrhage. No mass effect is seen. There are no extra-axial fluid collections. The ventricles and sulci are normal. The calvarium is unremarkable.

Cervical spine: There is a minimally displaced fracture of the left transverse process of C6 with minimal lateral distraction. An additional transverse process fracture on the left side of C7 and T1 and T2 is also present. These fractures involve the lateral aspect of the foramen transversarium. There is associated pleural thickening on the left side.

The remainder of the evaluation of the cervical spine is unremarkable. No significant degenerative changes are present.

IMPRESSION:

Normal brain.

Fractures of the transverse processes of the foramen transversarium on the left side at C6 and C7 as well as the left-sided transverse process of T1 and T2. The appearance suggests motion. Associated pleural thickening.

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EXAMINATION: MRA NECK WITH INTRAVENOUS CONTRAST

CLINICAL INDICATION: 51 years old female with recent trauma, C6 T2 fracture, concern for vascular injury

TECHNIQUE: Multiplanar multisequence MRI images of the neck were obtained. MRA images of the neck and Circle of Willis with 3D MIP reconstructions were also performed.

COMPARISON: C-spine CT on 8/20/2020

FINDINGS:

MRA neck:

Normal three-vessel branching pattern of the aortic arch. Origins of the common carotid arteries and vertebral arteries are patent.

Cervical segments of the vertebral arteries are patent. Tortuosity of the vertebral artery at the level of C4-C5 on the right within the transverse foramen with associated accentuated caliber to and C5-C6 on the left within the transverse foramen. No definite evidence of vertebral artery dissection or pseudoaneurysm.

Cervical segments of the internal carotid arteries are patent. Carotid bulbs are patent. External carotid arteries are patent.

IMPRESSION:

Patent vasculature of the neck. Tortuosity of the vertebral arteries on both sides without definite evidence of dissection or pseudoaneurysm.

EXAM: MRI of the cervical spine without contrast.

INDICATION: 51-year-old female with recent trauma and transverse process fracture. Further evaluation for ligamentous injury.

COMPARISON: CT C-spine on 8/20/2020

TECHNIQUE: Sagittal T1, T2, STIR, and axial T2 images of the cervical spine were acquired without contrast.

FINDINGS:

CERVICAL SPINE:

Alignment: Straightening of cervical spine lordosis. Otherwise, anatomic alignment.

Ligaments: Mild increased STIR signal along the interspinous ligaments extending from C4 to the upper thoracic spine as well as the posterior soft tissue C7-T3. Additional high STIR signal associated with the left transverse processes in the upper thoracic spine corresponding to the known fractures.

Increased epidural T2 hyperintense signal deep to the posterior longitudinal ligament at the C2 level, may represent small amount of epidural edema or venous engorgement. The T2-hyperintense structure within this prominent epidural T2 hyperintensity appears to be a vessel (4-12 and 5-1). The posterior longitudinal ligament itself appears intact.

Spinal cord: Normal signal is seen throughout the cervical and visualized upper thoracic spinal cord.

Bones: Limited visualization of left foreman transverse fracture (C6-7) and left-sided transverse process fracture T1-T2 better visualized on prior CT exam.

No significant degenerative changes throughout the cervical spine. No spinal canal stenosis or neural foraminal narrowing.

IMPRESSION:

1. Mild edema in the interspinous ligaments/posterior neck soft tissue (C4-T3), suggestive of edema/ligamentous sprain/injury. Some of this may represent infiltrative edema from the known transverse process fractures

2. Prominent ventral epidural increased T2/STIR signal deep to the posterior longitudinal ligament at the C2 level may represent epidural edema/venous engorgement without clear evidence of hemorrhage. The posterior longitudinal ligament itself appears intact

3. Normal alignment of cervical spine. Normal cervical spinal cord signal