Bullet-Shaped Vertebra/Anterior Vertebral Body Beaking



Bullet-Shaped Vertebra/Anterior Vertebral Body Beaking


Cheryl A. Petersilge, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Achondroplasia


  • Down Syndrome (Trisomy 21)


Less Common



  • Radiation-Induced Growth Deformities


  • Hypothyroidism (Congenital)


  • Pseudoachondroplasia


Rare but Important



  • Morquio Syndrome


  • Hurler Syndrome


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Bullet shape: Down, achondroplasia, pseudoachondroplasia, hypothyroidism, Hurler, Morquio


  • Anterior beaking: Achondroplasia, radiation-induced, Hurler, Morquio


Helpful Clues for Common Diagnoses



  • Achondroplasia



    • Rhizomelic dwarf


    • Exaggerated lumbar lordosis, posterior vertebral scalloping, narrow foramen magnum, congenital spinal stenosis, decreased interpediculate distance


    • Squared iliac wings, narrow sciatic notch, horizontal acetabular roof


    • Trident hand, flared anterior ribs


  • Down Syndrome (Trisomy 21)



    • Congenital heart disease, GI abnormalities


    • Brachycephaly, abnormal facies


    • Short stature, atlantoaxial instability, developmental hip dysplasia


Helpful Clues for Less Common Diagnoses



  • Radiation-Induced Growth Deformities



    • Regional osteoporosis ± scoliosis


  • Hypothyroidism (Congenital)



    • Mental retardation, delayed growth, short stature, stippled epiphyses


    • Abnormal skull and face with thick protruding tongue, delayed dentition


  • Pseudoachondroplasia



    • Rhizomelic dwarf


    • C1-2 subluxation, accentuated lumbar lordosis, early osteoarthritis


    • Short thick tubular bones especially in hands and feet, metaphyseal excrescences


Helpful Clues for Rare Diagnoses



  • Morquio Syndrome



    • Short stature, macrocephaly, coarse facial features, widely spaced teeth


    • Odontoid hypoplasia, increased lumbar lordosis, bell chest, & paddle-shaped ribs


    • Flared iliac wings, inferior tapering iliac bones, steep acetabuli, coxa valga


  • Hurler Syndrome



    • Mental retardation, short stature


    • Coarse facial features, macrocephaly, and other craniovertebral anomalies including J-shaped sella


    • Small iliac bones with inferior tapering, steep acetabuli, abnormal femoral heads


    • Thickened tubular bones, contractures


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Aug 10, 2016 | Posted by in PEDIATRICS | Comments Off on Bullet-Shaped Vertebra/Anterior Vertebral Body Beaking

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