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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2013 January-February;172(1-2):119-22

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

Imaging of aplasia of the posterior arch of the atlas with persistent posterior tubercle: a case report

Pierro A. 1, Restaino G. 1, Missere M. 1, Maselli G. 1, Giordano G. 2, Sallustio G. 1

1 Radiology Department, Fondazione di Ricerca e Cura, “Giovanni Paolo II”, Campobasso, Italy; 2 Oncohematology Department, Fondazione di Ricerca e Cura, “Giovanni Paolo II”, Campobasso, Italy


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A 70-year-old man with plasmablastic lymphoma underwent skeletal survey that documented the presence of multiple osteolytic bone lesions in the left tibia, skull and forearm, finding not common in this disease. Radiographs of the cervical spine showed an abnormal appearance of the arch of the atlas with the presence of a posterior bone fragment, located cranial to the spinous process of epistropheus. This morphological abnormality, although suspected to anatomical variation, we were not allowed, only with the X-ray examination, to exclude the presence of osteolytic bone changes at that level, so the patient underwent magnetic resonance imaging (MRI) and computed tomography (CT) of the cervical spine. CT confirmed the congenital abnormality, while MRI has ruled out changes in the spinal cord. This anatomical variation, uncommon, poses problems of differential diagnosis to radiographic examination alone, in patients with multiple osteolytic lesions or even in patients who have suffered trauma, and therefore know the typical appearance of this anatomical variation, and as it presents itself in various modes imaging is of paramount importance both for the radiologist and for the clinician. Furthermore, this case shows an uncommon finding for plasmablastic lymphoma that is, multiple osteolytic lesions.

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