ClariPACS

PNR CS 4

History

5 yo F hit with a rock, left and posterior neck pain

Major Findings 

  • Asymmetric widening of the left lateral mass of C1 and the left occipital condyle. 
  • Associated small bone fragment between the lateral mass and the occipital condyle; no donor site identified

Teaching Points

The dens of C2 has a small rounded fragment at the top. This is a normal secondary ossification center called an ossiculum terminale, which appears between ages 3-6 and usually fuses by age 12. Some patients have persistence of this ossification center, called persistent ossiculum terminale.

Another odontoid variant is an os odontoideum, which can be associated with atlantoaxial instability.

Don't mistake these normal variants for an odontoid fracture!

Important article on pediatric C-spine trauma imaging: 



Accession: CL0670

Study description: CT SPINE CERVICAL W/O CONT

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