We present the case of a 31-year-old trauma patient with computed tomography concerning significant C3–C4 subluxation. The abnormality is due to an artifact with which emergency physicians should be aware

Kendall, John L.

Shockley, Lee W.

English

PubMed

We present the case of a 31-year-old trauma patient with computed tomography concerning significant C3-C4 subluxation. The abnormality is due to an artifact with which emergency physicians should be aware. [West J Emerg Med. 2011;12(2):240-241.

eScholarship - University of California

UC IrvineWestern Journal of Emergency Medicine: Integrating Emergency Care with Population HealthTitleArtifact Simulating Fracture on Cervical Spine Computed TomographyPermalinkhttps://escholarship.org/uc/item/85w1s9jbJournalWestern Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 12(2)ISSN1936-900XAuthorsShockley, Lee W.Kendall, John L.Publication Date2011Copyright InformationCopyright 2011 by the author(s).This work is made available under the terms of a Creative Commons Attribution-NonCommercial License, available at https://creativecommons.org/licenses/by-nc/4.0/ Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of CaliforniaVolume XII, no. 2  :  May 2011   240 Western Journal of Emergency MedicineImages In emergency medIcIne	 	 	 						Artifact	Simulating	Fracture	on		 	 	 	 	Cervical	Spine	Computed	TomographyLee W. Shockley, MD, MBA   John L. Kendall, MD   	 Denver	Health	Medical	Center,	The	University	of	Colorado	School	of	MedicineSupervising Section Editor: Sean	Henderson,	MDSubmission	history:	Submitted:	August	18,	2010;	Accepted	August	23,	2010.	Reprints	available	through	open	access	at	http://escholarship.org/uc/uciem_westjem.	We	present	the	case	of	a	31-year-old	trauma	patient	with	computed	tomography	concerning	significant	C3-C4	subluxation.	The	abnormality	is	due	to	an	artifact	with	which	emergency	physicians	should	be	aware.	[West	J	Emerg	Med.	2011;12(2):240-241.]A 31-year-old woman fell from a van traveling between 20-40 miles per hour. She briefly lost consciousness. She was immobilized on a backboard with towel rolls and tape because a standard extrication collar would not fit. The patient was confused and agitated with a Glasgow Coma Scale of 12. She moved all four extremities and had a large posterior scalp laceration. Computed tomography (CT) of her head was normal except for the laceration. The sagittal reconstruction of her cervical spine CT is shown (Figure 1).The image was initially interpreted as a 4 mm of subluxation of C3 on C4. This was consistent with the presumed hyperflexion mechanism of injury. Physiologic subluxation of C2 on C3 is a normal finding in up to 9% of children under age seven years.1, 2 This is probably due to Figure 2. Axial	image	from	the	computed	tomography	at	C3-C4.Figure 1. Lateral	c-spine	sagittal	reconstruction	from	the	com-puted	tomography.Western Journal of Emergency Medicine  241 Volume XII, no. 2  :  May 2011immature muscular development and hypermobile spines. There is at least one published report of an adult with C2 on C3 pseudosubluxation.3 However, C3 on C4 subluxation is always considered abnormal (Figure 2).There are clues of a movement artifact on this image, such as the lack of soft tissue swelling, a sharply irregular line of the posterior pharynx, and an oddly shaped mandible. Examination of the axial image at the C3-C4 area revealed that the patient moved 4mm and assumed a new position for the remainder of the study. Recognition of this movement artifact is important in the accurate evaluation of spine CT scans.Address for Correspondence: Lee	W.	Shockley,	MD,	MBA,	Denver	Health	Medical	Center,	The	University	of	Colorado	School	of	Medicine,	Email	Lee.Shockley@dhha.org.	Conflicts of Interest: By	the	WestJEM	article	submission	agree-ment,	all	authors	are	required	to	disclose	all	affiliations,	funding	sources,	and	financial	or	management	relationships	that	could	be	perceived	as	potential	sources	of	bias.	The	authors	disclosed	none.REFERENCES 1.	 Betz	RR,	Mulcahey	MJ,	D’Andrea	LP,	et	al.	Acute	evaluation	and	management	of	pediatric	spinal	cord	injury.	J Spinal Cord Med.	2004;27	Suppl	1:S11-5.2.	 Shaw	M,	Burnett	H,	Wilson	A,	et	al.	Pseudosubluxation	of	C2	on	C3	in	polytraumatized	children--prevalence	and	significance.	Clin Radiol.	Jun	1999;54(6):377-80.3.	 Curtin	P,	McElwain	J.	Assessment	of	the	“nearly	normal”	cervical	spine	radiograph:	C2-C3	pseudosubluxation	in	an	adult	with	whiplash	injury.	Emerg Med J.	Dec	2005;22(12):907-8.Cervical Spine CT Shockley et al.

Artifact Simulating Fracture on Cervical Spine Computed Tomography

Shockley, Lee

Kendall, John

Directory of Open Access Journals

Western Journal of Emergency Medicine

Acute evaluation and management of pediatric spinal cord injury.

Assessment of the “nearly normal” cervical spine radiograph: C2-C3 pseudosubluxation in an adult with whiplash injury. Emerg Med

Pseudosubluxation of C2 on C3 in polytraumatized children--prevalence and significance. Clin Radiol.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3099616

Artifact Simulating Fracture on Cervical Spine Computed Tomography

Abstract

Similar works

Full text

Available Versions

eScholarship - University of California

Directory of Open Access Journals