Anatomical distribution of vertebral fractures: comparison of pediatric and adult spines

SUMMARY

We compared the distribution of vertebral fractures in adults and children and found that fractures occurred in different locations in the two age groups. This likely relates to the different shape of the immature spine.

INTRODUCTION

We hypothesized that the anatomical distribution of vertebral fractures (VF) would be different in children compared to adults.

METHODS

We compared the distribution of VF defined using the Genant semi-quantitative method (GSQ method) in adults (N = 221; 545 fractures) and in children early in the course of glucocorticoid therapy (N = 44; 94 fractures).

RESULTS

The average age in the adult cohort was 62.9 years (standard deviation (SD), 13.4 years), 26% was male, the mean lumbar spine Z-score was -1.0 (SD, 1.5), and the corresponding T-score was -2.4 (SD, 1.4). The pediatric cohort median age was 7.7 years (range, 2.1-16.6 years), the mean lumbar spine Z-score was -1.7 (SD, 1.5), 52% was male, and disease categories were acute lymphoblastic leukemia (66%), rheumatological conditions (21%), and nephrotic syndrome (14%). The VF distribution was biphasic in both populations, but the peaks differed in location. In adults, the peaks were at T7/T8 and at T12/L1. In children, the focus was higher in the thoracic spine, at T6/T7, and lower in the lumbar spine, at L1/L2. When children were assessed in two age-defined sub-groups, a biphasic VF distribution was seen in both, but the upward shift of the thoracic focus to T6 was observed only in the older group, with the highest rates of fracture present between ages 7 and 10 years.

CONCLUSIONS

These results suggest that the anatomical distribution of VF differs between children and adults, perhaps relating to the different shape of the immature spine, notably the changing ratio of kyphosis to lordosis.

The secondary pulmonary lobule: normal and abnormal CT appearances

The secondary pulmonary lobule is a unit of lung supplied by three to five terminal bronchioles and contained by fibrous septa. High-resolution CT is able to show features of the secondary lobule, including interlobular septa, terminal bronchioles, and pulmonary arteries within a bronchiolovascular bundle. Because interstitial diseases have been shown to affect different components of the secondary lobule, high-resolution CT was used to compare the appearance of the normal secondary lobule with the abnormal secondary lobule in three patients with interstitial diseases primarily affecting lymphatic channels: lymphangitic carcinomatosis, sarcoidosis, and lymphangioleiomyomatosis. In lymphangitic carcinomatosis, the bronchiolovascular bundles and interlobular septa were thicker than those seen in a normal subject. In sarcoidosis, the interlobular septa and bronchiolovascular bundles were also thicker than normal. However, fibrosis caused distortion of the normal polygonal shape of the secondary lobule, not seen in either the normal subject or the patient with lymphangitic carcinomatosis. Lymphangioleiomyomatosis was characterized by multiple cysts within secondary lobules, often obliterating the normal polygonal appearance.

Fungal microabscesses in immuno-suppressed patients--CT appearances

Disseminated fungal infections in leukemic patients treated with cytotoxic drugs are an increasing problem. Confirmation of such infection either by clinical or laboratory examination can be extremely difficult. The findings in four such patients, using computed tomography, are described here. The presence of small non-enhancing lesions in the liver, spleen, or kidney in such patients is strongly suggestive of deep-seated fungal infections.

Hibernoma: a patient examined by CT

We describe the computed tomographic (CT) findings in a patient with a hibernoma of the thigh, a rare tumor of brown fat. There are no specific features to allow differentiation from the more common low grade liposarcoma. This is in agreement with the only other published report of the CT features of hibernoma. Although preoperative diagnosis requires biopsy, CT is of value in detecting fatty tumors and in preoperative planning.

CO2 delivery system for double-contrast barium enema examinations

Patient discomfort following double-contrast barium enema examinations can be significantly reduced by using CO2 instead of room air. We describe an inexpensive and easily constructed CO2 delivery system for this examination.

The musculoskeletal manifestations of cystic fibrosis

Twenty-seven patients with CF and joint complaints were reviewed. Twelve patients had arthritis, 11 had HPO, and four had symptoms of mechanical neck and back pain. We have confirmed the association of CF with an episodic form of arthritis. For the first time, we have reported that a subgroup of these patients later develop persistent synovitis with progressive asymmetric, erosive disease. The etiology of CF arthritis is unclear, but may relate to chronic infection and immune complex mechanisms. CF arthritis can be contrasted with CF induced HPO, which is associated with worse lung disease, a male predominance, and an older mean age of onset of symptoms. Mechanical neck and back pain may relate to an associated scoliosis or kyphosis in CF.