Presentation
Severe neck pain, not moved out of chair for days. Also pains in low back / legs.
Patient Data
Collapse of the C2 vertebral body with anterior translation of C1 and the odontoid process. There is also lysis of the posterior body of C6.
At the edge of the axial studies, there is a large right lower lobe mass with a satellite lesion and right hilar / subcarinal nodal disease.
Imaging degraded by motion.
Metastatic disease is demonstrated in all the imaged vertebral levels, including the left occipital condyle, with the largest deposits in C2, C6, C7, T9, T11, L1 and L3. Soft tissue disease fills the left C2, left T9 and bilateral L1 exit foramina. The soft tissue around C2 is expanded and there is abnormal signal suggesting infiltration into the prevertebral space. The vertebral canal is narrowed around the L1 level but the signal of the conus and other intradural structures is normal. No spinal cord compression.
Case Discussion
A number of pathologies can lead to deformity and destruction of the C2 odontoid process, but the presence of other vertebral lesions and the lung mass makes metastatic disease by far the most likely etiology. There were a number of other skeletal lesions confirmed on body imaging.
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