Presentation
Back pain.
Patient Data
L1 vertebral body compression fracture with moderate loss of vertebral body height (35%). The changes of endplate sclerosis suggest a chronic fracture, however, the associated bone marrow edema on the dual-energy images implies an acute on chronic component.
L2 old vertebral body compression fracture with moderate loss of vertebral body height (50%). No retropulsed fragment. No bone marrow edema.
L2/L3 shallow posterior disc bulge. L5/L1 shallow posterior disc bulge, eccentric to the left with mild left neural exit foraminal narrowing. No prevertebral or para-spinal soft tissue abnormality. No pelvic or femur fracture.
Incidental 4 mm right intrarenal calculi.
Conclusion:
Acute on chronic L1 vertebral body compression fracture with moderate loss of vertebral body height.
Case Discussion
CT with dual-energy is helpful in identifying increased attenuation of bone marrow suggestive of bone marrow edema, in this instance suggesting the presence of an acute on chronic insufficiency fracture.
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