Answer for BIR CoW 29 Jun 2025
Skeletal blastic metastasis
Findings
Plain X ray AP and Lateral view DL spine reveals, Absent bilateral breast shadow reflecting Bilateral mastectomy status. Dense sclerotic D11 and D12 vertebral body( ivory vertebrae) noted with absent bilateral pedicle in D12 vertebrae. No e/o vertebral body collapse / destruction No e/o reduced intervertebral disc space / soft tissue / collection. Impression: Known case of HPE proven invasive ductal carcinoma of bilateral breast S/p Bilateral mastectomy Present study shows, Sclerotic metastatsis involving D11 and D12 vertebral body.
Discussion
The term "ivory vertebra" refers to a radiologic sign where a vertebral body appears uniformly sclerotic and increased in density (whiter than normal) on imaging, especially plain X-rays, CT, or sometimes MRI (as low signal on both T1 and T2). Key Characteristics: Entire vertebral body appears homogeneously sclerotic (white/dense). Disc spaces are usually preserved. No associated vertebral body collapse or bone destruction initially. Features Top three DD for Ivory vertebra Blastic Hodgkin Pagets metastasis lymphoma disease Age >45 20-40 >50 Expansion and squaring of VB No No Yes Anterior VB scalloping No yes No Posterior cortex bulge yes No No Differential diagnosis of an Ivory Vertebra(Mnemonic: PHOENIX) P: Paget’s disease -Abnormal bone remodeling; often in elderly; may involve thickened trabeculae and cortical bone. H: Hodgkin lymphoma - one of the classic associations; tends to involve the anterior vertebral body. O: Osteoblastic metastases-Especially from prostate (in men), breast, carcinoid, and bladder cancers E: Eosinophilic granuloma (Langerhans Cell Histiocytosis)Less common; usually in children/young adults; more likely to cause vertebra plana, but may initially appear sclerotic N: Neuroblastoma metastases Seen in children; I: Infection (chronic sclerosing osteomyelitis)Rare cause; tends to affect the vertebral body uniformly. X: Xtra (miscellaneous)e.g., idiopathic, post-radiation changes.
References:
1. Graham TS. The ivory vertebra sign. Radiology. 2005;235 (2): 614-5. doi:10.1148/radiol.2352021743 - Pubmed citation
2. Donald Resnick. Diagnosis of Bone and Joint Disorders. 4th Edition (2002)
3. Parlier-Cuau C, Laredo J. [Vertebral involvement in SAPHO syndrome]. (2010) Journal de radiologie. 91 (9 Pt 2): 1068-78. Pubmed
Findings
Plain X ray AP and Lateral view DL spine reveals, Absent bilateral breast shadow reflecting Bilateral mastectomy status. Dense sclerotic D11 and D12 vertebral body( ivory vertebrae) noted with absent bilateral pedicle in D12 vertebrae. No e/o vertebral body collapse / destruction No e/o reduced intervertebral disc space / soft tissue / collection. Impression: Known case of HPE proven invasive ductal carcinoma of bilateral breast S/p Bilateral mastectomy Present study shows, Sclerotic metastatsis involving D11 and D12 vertebral body.
Discussion
The term "ivory vertebra" refers to a radiologic sign where a vertebral body appears uniformly sclerotic and increased in density (whiter than normal) on imaging, especially plain X-rays, CT, or sometimes MRI (as low signal on both T1 and T2). Key Characteristics: Entire vertebral body appears homogeneously sclerotic (white/dense). Disc spaces are usually preserved. No associated vertebral body collapse or bone destruction initially. Features Top three DD for Ivory vertebra Blastic Hodgkin Pagets metastasis lymphoma disease Age >45 20-40 >50 Expansion and squaring of VB No No Yes Anterior VB scalloping No yes No Posterior cortex bulge yes No No Differential diagnosis of an Ivory Vertebra(Mnemonic: PHOENIX) P: Paget’s disease -Abnormal bone remodeling; often in elderly; may involve thickened trabeculae and cortical bone. H: Hodgkin lymphoma - one of the classic associations; tends to involve the anterior vertebral body. O: Osteoblastic metastases-Especially from prostate (in men), breast, carcinoid, and bladder cancers E: Eosinophilic granuloma (Langerhans Cell Histiocytosis)Less common; usually in children/young adults; more likely to cause vertebra plana, but may initially appear sclerotic N: Neuroblastoma metastases Seen in children; I: Infection (chronic sclerosing osteomyelitis)Rare cause; tends to affect the vertebral body uniformly. X: Xtra (miscellaneous)e.g., idiopathic, post-radiation changes.
References:
1. Graham TS. The ivory vertebra sign. Radiology. 2005;235 (2): 614-5. doi:10.1148/radiol.2352021743 - Pubmed citation
2. Donald Resnick. Diagnosis of Bone and Joint Disorders. 4th Edition (2002)
3. Parlier-Cuau C, Laredo J. [Vertebral involvement in SAPHO syndrome]. (2010) Journal de radiologie. 91 (9 Pt 2): 1068-78. Pubmed
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!