Indian Journal of Nuclear Medicine
Home | About IJNM | Search | Current Issue | Past Issues | Instructions | Ahead of Print | Online submissionLogin 
Indian Journal of Nuclear Medicine
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 47 Print this page  Email this page Small font size Default font size Increase font size


 
 Table of Contents     
INTERESTING IMAGES
Year : 2015  |  Volume : 30  |  Issue : 2  |  Page : 183-184  

Bone single-photon emission computed tomography and three-dimensional computed tomography in the diagnosis of low costal variation and pathologies


1 Department of Nuclear Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
2 Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey

Date of Web Publication11-Mar-2015

Correspondence Address:
Dr. Güler Silov
Department of Nuclear Medicine, Kayseri Training and Research Hospital, Kayseri 38010
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.152990

Rights and Permissions
   Abstract 

In general, there are five lumbar vertebras in normal human subjects. But occasionally there are six. In such a situation, a radiologist need to discern between lumbarization of S1 (S1 vertebra becomes segmented and mimics L5) or due to hypoplastic 12 th ribs, hence the T12 vertebra is wrongly assumed to be L1. These interesting images serve a multimodality approach to right aplasia/left hypoplasia of 12 th rib, injury of left 11 th rib and subluxation of left 11 th Costovertebral joint in a patient with lumbar back pain.

Keywords: Bone single-photon emission computed tomography, costal variation/pathologies, three-dimensional computed tomography


How to cite this article:
Silov G, Erdoğan Z, Özdal A, Özaşlamacı A. Bone single-photon emission computed tomography and three-dimensional computed tomography in the diagnosis of low costal variation and pathologies. Indian J Nucl Med 2015;30:183-4

How to cite this URL:
Silov G, Erdoğan Z, Özdal A, Özaşlamacı A. Bone single-photon emission computed tomography and three-dimensional computed tomography in the diagnosis of low costal variation and pathologies. Indian J Nucl Med [serial online] 2015 [cited 2019 Dec 15];30:183-4. Available from: http://www.ijnm.in/text.asp?2015/30/2/183/152990

A 37-year-old woman with left low back pain for 3 mount durations was admitted to the department of orthopedic surgery and traumatology. Patient was not described any major trauma. Her laboratory finding was compatible with iron deficiency anemia. Other serologic and hematologic results are within normal limits. On anteroposterior and lateral radiography at first glance, there was six lumbar vertebra [Figure 1]a. This distinction matters little to the health of the patient him/herself but can have a terrible effect if the surgeon decides to operate on him/her and there is a misconception of the level. [1],[2],[3] There are typically no anatomic complications using the anterior approach from beneath the costal margin. The posterior approach requires an incision at the level of the spinous process of the first lumbar vertebra to avoid entering the pleura. [4],[5],[6] On the thoracolumbar computed tomography (CT), there was only five lumbar vertebra and right 12 th rib aplasia and left 12 th rib hypoplasia [Figure 1]b. But there was no pathological finding to explain the pain.
Figure 1: (a) At first glance, there were six lumbar vertebrae on the anteroposterior radiography (b) There were only five lumbar vertebrae and right 12th rib aplasia and left 12th rib hypoplasia (arrow) on the thoracolumbar computed tomography

Click here to view


The patient with intense low back pain was also further investigated with three phase bone scintigraphy (TPBS), whole body bone scintigraphy (WBBS) and thoracolumbar bone single-photon emission computed tomography (SPECT). There were no abnormal findings on the first two phase of TPBS. On the WBBS, there were not seen the ribs of 12 th and moderate diffuse activity involvement was observed on the left 11 th rib [Figure 2]a. In the coronal SPECT images, there was diffuse increased uptake in the left 11 th rib [Figure 2]b. On the three-dimensional-CT imaging, left 12 th hypoplastic rib was observed while right one was not. Also left 11 th Costovertebral joint was subluxated [Figure 3]. Ribs 11 and 12 do not attach to an anterior costal cartilage or transverse process, but rather invest into the fascia and musculature of the lateral and posterior abdominal wall. Ribs 11 and 12 are described as having caliper motion, primarily influenced by their relationship to their muscular attachments. The caliper motion of ribs eleven and twelve can be seen to be related to the near-vertical orientation of the small transverse processes of T11 and T12 as well as the way the ribs invest into the abdominal musculature, thoracolumbar fascia, and diaphragm. Another important lower extremity muscle affecting rib cage motion is the quadrates lumborum, which originates from the iliolumbar ligament and the posterior part of the iliac crest, runs along the posterior lateral aspect of the vertebral column, and inserts on the transverse processes of the upper four lumbar vertebra and the inferior aspect of the 12 th rib on each side. [7] According to all of these findings, repetitive daily minor posttraumatic subluxation of the left 11 th rib and injury was diagnosed in this patient.
Figure 2: (a) There were not seen the ribs of 12th and moderate diffuse activity involvement was observed on the left 11th rib on the whole body bone scintigraphy (b) There was diffuse increased uptake in the left 11th rib (arrow) on the coronal single-photon emission computed tomography images

Click here to view
Figure 3: On the three-dimensional computed tomography imaging, left 12th hypoplastic rib (arrow) was observed while right one was not. Also left 11th costovertebral joint was subluxated

Click here to view


 
   References Top

1.
Merks JH, Smets AM, Van Rijn RR, Kobes J, Caron HN, Maas M, et al. Prevalence of rib anomalies in normal Caucasian children and childhood cancer patients. Eur J Med Genet 2005;48:113-29.  Back to cited text no. 1
    
2.
Edwards DK 3 rd , Berry CC, Hilton SW. Trisomy 21 in newborn infants: Chest radiographic diagnosis. Radiology 1988;167:317-8.  Back to cited text no. 2
    
3.
Grangé G, Tantau J, Acuna N, Viot G, Narcy F, Cabrol D. Autopsy findings related to Down's syndrome: 101 cases. J Gynecol Obstet Biol Reprod (Paris) 2006;35:477-82.  Back to cited text no. 3
    
4.
Spain DA, Martin RC, Carrillo EH, Polk HC Jr. Twelfth rib resection. Preferred therapy for subphrenic abscess in selected surgical patients. Arch Surg 1997;132:1203-6.  Back to cited text no. 4
    
5.
Kato H, Kiyokawa H, Inoue H, Kobayashi S, Nishizawa O. Anatomical reconsideration to renal area: Lessons learned from radical nephrectomy or adrenalectomy through a minimal incision over the 12 th rib. Int J Urol 2004;11:709-13.  Back to cited text no. 5
    
6.
Kato H, Nishizawa O. Supracostal approach - An excellent exposure for renal and adrenal surgery. Hinyokika Kiyo 2001;47:449-52.  Back to cited text no. 6
    
7.
De Stefano LA. Greenman's Principles of Manual Medicine. Philadelphia: Lippincott; 2011. p. 265-6.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    References
    Article Figures

 Article Access Statistics
    Viewed1008    
    Printed16    
    Emailed0    
    PDF Downloaded56    
    Comments [Add]    

Recommend this journal