Hello. My name is Jack Henry, DC, DACBR. I am Radiologist-in-Chief of
Radiology Diagnostics, LLC, an industry leader of Chiropractic Radiology Services and Digitized Spinographic analyses. All of our services are provided at no cost to doctor and no/low cost to patients.
Selected cases will be presented for your evaluation. The studies may or may not have abnormalities. Use the arrow keys or the scroll bar to carefully evaluate the films.
Step 1: Is the study abnormal or normal?
Step 2: If the study is abnormal, what is your best diagnosis?
Step 3: Which follow-up imaging option would be best?
Step 4: Compare your results with the correct diagnosis.
HISTORY
A 41-year-old male reports with cervical spine pain and stiffness after recent flexion extension injury. The patient’s clinical findings and past medical history were not provided.
FINDINGS
The study is negative for acute fracture or dislocation. Osteopenia is noted. However, this finding may be accentuated due to technical factors. Mild degenerative changes are present within the cervical spine. Degenerative anterior stair-stepping is noted at C4 on C5 and C5 on C6 of approximately 5% at their respective levels. Mild developmental wedging and/or old mild compaction deformities are present at the C5, C6, and C7 vertebral bodies. Please note the multiple calcific radiodensities throughout the left posterior lateral cervical soft tissues.
DISCUSSION
The densities noted most likely represent phleboliths secondary to a soft tissue hemangioma. I was not privileged to the patient’s history. However, I would not be surprised if there was associated visualized soft tissue abnormality. It is important for the attending to give the radiologist (or other specialist) important clinical information for a more precise diagnosis.
FOLLOW UP PROTOCOL
This lesion most likely represents a soft tissue hemangioma. The patient is probably aware of his condition. More importantly, is this region “safe” to adjust? I am not aware of specific complications related to chiropractic adjustments, notwithstanding the clinician should be cognizant of bleeding and ulceration potential from hemangiomas.