Thoracic Compresson Fracture

A compression fracture of the thoracic spine most often happens when there is too much pressure placed on the body of a vertebrae. The most common causes of a thoracic compression fracture are osteoporosis, car accidents, falls, or some type of metastases.

When a thoracic vertebrae is compressed, it most often takes on the shape of a wedge which you can see in the image to the left. Sometimes this wedging can be severe enough that the fractured vertebral body has nowhere to go and ends up pushing out into the spinal canal and compressing the spinal cord.

Thoracic compression fractures are usually pretty apparent right away. They often cause pain not only in the back itself but also in the legs and arms. In some cases when the spinal nerves surrounding the vertebrae are involved in the injury weakness and numbness of the legs and arms can also occur.

The most common treatments for thoracic compression fractures are pain medicines, a lowering of a patient's activity level, or wearing a brace. Surgery is very unlikely for compression fractures unless the case is extremely severe.

CT is usually the modality of choice for the imaging of these types of fractures but MRI can be used in order to determine if surrounding nerves or ligaments are involved.

I found my information for this blog at www.umm.edu/spinecenter and my image at www.learningradiology.com

Hangman's Fracture

A hangman's fracture is unique in that it can only occur in one place in our bodies, the axis or C-2 vertebrae. A hangman's fracture occurs when the arch of C-2, most commonly involving both pedicles or pars interarticularis. This is most commonly the result after execution by hanging or anytime the neck is severely hyperextended such as in a car accident. Oddly enough, when a person uses hanging as a means of suicide, the victim most often dies from lack of oxygen, not a hangman's fracture because there is not enough force exerted on the neck. Sublaxation of C-2 on C-3 commonly occurs along with a Hangman's Fracture.

The most frequent sign of a Hangman's fracture is some type of motor function most often due to a compressed cervical nerve or more seriously, compression of the spinal cord. Unfortunately, if the spinal cord is cut, the patient will most likely not survive.

The most common treatment for a hangman's fracture is some type of immobilization. Whether with a stiff C-Collar in the case of stable fractures or with a halo in the case of unstable fractures.

Surgical repair is also sometimes necessary to relieve pressure from the spinal cord and ensure proper alignment. Whether the patient has a stable or unstable fracture, many weeks of bed rest are in their future. The patient recovering from a Hangman's Fracture should consider themselves very lucky to be alive.

I found my picture at imaging.consult.com and my information about Hangman's Fractures on wikipedia.org and in the book Radiographic Pathology for Technologists by Mace and Kowalczyk.

Goiter

For pathology of the neck I decided to research goiters. I have never actually seen one while working in CT but thought it might be interesting to find out more about them. While doing my research, I had a hard time finding any radiologic images but did actually find a LOT of regular pictures of people with goiters. I never realized how big they could get!!

The CT image above shows a large goiter that is actually compressing this patient's trachea and making breathing very difficult.

The two most common causes of a goiter are a lack of iodine in the diet or more frequently for people here in the United States, an overproduction of thyroid stimulating hormone or TSH.

Goiters can cause several types of complications including compression or the esophagus and trachea which could mean difficulty swallowing or breathing. Other problems can include a cough that won't go away or changes in the pitch of a person's voice.

Treatments for goiter can be as simple as medication to control TSH production or even surgery to remove the goiter. The problem with using medication as a treatment is that it usually will not shrink the goiter, but instead prevent it from growing any larger. In this case, surgery would be the treatment option of choice.

I found the information for this blog on endocrineweb.com.