Imaging Case of the Week 33

A 57 year old man presents with mid thoracic back pain that has been keeping him awake at night for the past few weeks. The thoracic spine x-rays are enclosed. What can you see?

Thoracic spine lateral

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Thoracic spine AP

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[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The xray shows complete sclerosis of the T5 vertebra. There is no associated fracture and adjacent disc spaces are maintained.

Considering the patient’s age and gender, the most likely causes for this ivory vertebra are metastatic ca prostate and Non-Hodgkin’s lymphoma.

This patient had high PSA levels and was later diagnosed with Ca prostate.

Differential diagnosis of ivory (sclerotic) vertebra in adults:

  • Metastasis (osteoblastic) – prostate ca, breast ca.
  • Lymphoma
  • Paget’s disease (causes expansion of the vertebra).