• 论坛首页
  • 我的丁香客
  • 找人
    查找好友
  • 更多
    丁香园
    丁香通
    丁香人才
    丁香会议
    丁香搜索
    丁香医生
    丁香无线
    丁香导航
    丁当铺
    文献求助
    医药数据库
    丁香诊所
    来问医生
登录 注册

超声医学

关注今日：14 | 主题：864571
论坛首页  >  超声医学讨论版   >  翻译进展
  • 发帖
    每发1个新帖
    可以获得0.5个丁当奖励
  • 回帖

分享到：

  • 微信

    微信扫一扫

  • 微博
  • 丁香客
  • 复制网址

【读片】产科疑难超声病例（329）：蝴蝶椎

  • 只看楼主
  • 页码直达：
  • 直达末页
  • 图片模式
zhangming123456
zhangming123456
科室保密
常驻站友

  • 3
    积分
  • 8
    得票
  • 142
    丁当
  • 106楼
猜一个难道是连体双胎
2012-10-27 08:51
  • 投票
  • 收藏 2
  • 打赏
  • 引用
  • 分享

    • 微信扫一扫

    • 新浪微博
    • 丁香客
    • 复制网址
  • 举报
    • 广告宣传推广
    • 政治敏感、违法虚假信息
    • 恶意灌水、重复发帖
    • 违规侵权、站友争执
    • 附件异常、链接失效
    • 其他
  • • 今天会出规培考试成绩吗
ydh841215
ydh841215
超声科
常驻站友

  • 1
    积分
  • 8
    得票
  • 68
    丁当
  • 107楼
猜个，貌似没看到棘突，等待拍砖。。。
2012-10-27 09:03
  • 投票
  • 收藏
  • 打赏
  • 引用
  • 分享

    • 微信扫一扫

    • 新浪微博
    • 丁香客
    • 复制网址
  • 举报
    • 广告宣传推广
    • 政治敏感、违法虚假信息
    • 恶意灌水、重复发帖
    • 违规侵权、站友争执
    • 附件异常、链接失效
    • 其他
  • • 规培结业考试通过，祈祷顺利
楼主 xihuansushi
xihuansushi
超声科

丁香园版主

  • 820
    积分
  • 3798
    得票
  • 1582
    丁当
  • 108楼
34-year-old patient (G1P0) without remarkable history. Nuchal transluency, triple test , karyotype was normal.
Final diagnosis: Butterfly veterbra
本例最终诊断为蝴蝶椎。

Image and video 1-3: Arrow showing the butterfly vertebra
箭头所指为蝴蝶椎





Image 4, 5: Butterfly vertebra
蝴蝶椎


Image 6-8: Xray scan; arrows showing the abnormal vertebra.
产后X线所示
2012-10-27 09:15
  • 投票 2
  • 收藏 1
  • 打赏
  • 引用
  • 分享

    • 微信扫一扫

    • 新浪微博
    • 丁香客
    • 复制网址
  • 举报
    • 广告宣传推广
    • 政治敏感、违法虚假信息
    • 恶意灌水、重复发帖
    • 违规侵权、站友争执
    • 附件异常、链接失效
    • 其他
xihuansushi 编辑于 2012-10-27 09:21
  • • 少见病例 腹膜后脓肿？
楼主 xihuansushi
xihuansushi
超声科

丁香园版主

  • 820
    积分
  • 3798
    得票
  • 1582
    丁当
  • 109楼
Synonyms: Sagittal cleft, midline vertical cleft

Definition: “Butterfly vertebra” is an uncommon congenital anomaly of the spine. It results from the failure of fusion of the lateral halves of the vertebral body because of persistent notochondal tissue between them forming a cleft in the center.[1][2]

On frontal X-ray, the two half-vertebrae resemble the wings of a butterfly wings while the processus spinosus represents the butterfly body.

History: In an early study of the vertebral column in the South African Bantu, Shore (1930) noted an unusual fifth thoracic vertebra in a 40-year-old Basutu male. He described the vertebral body as wedged-shaped, its anterior height reduced by approximately 6.5 mm (40%), and he felt that is clearly represented a “developmental phenomenon”. He also noted that this apparent expression of sagittal clefting was the only one observed in 1,936 Bantu vertebrae studied. An example of sagittal clefting was reported for the skeleton of a middle-aged adult recovered from Krasnojarski Kray near the village of Podgornoe in eastern Siberia. The site is dated from the sixth to fifth centuries BC. Because its appearance resembles the wings of the butterfly, so it is called butterfly vertebrae.[3]


Prevalence: The prevalence of butterfly vertebra in the general population is uncommon but poorly known with less than 100 case reports, yet some dedicated studies have found numbers as high as 1:5000 .[3],[4],[5]

Etiology: unknown

Pathogenesis: It results from separate bilateral ossification center that fail to unite [1] which should happen around the seventh week of gestational age and end at the 25th week[6]. Abnormal ossification of the vertebral body happens centrally, probably after incomplete fusion of two cartilaginous centers with hypoplasia at the junctional site. Butterfly vertebrae can result from a developmental abnormality leading to regression of the cauda dorsalis and formation of sagittal clefts in the vertebra into right and left halves. There are usually no symptoms. Butterfly vertebrae of normal height do not necessarily result in deviation of the spinal column axis. These most common occur in the thoracic region, but occasionally will be found in the lumber spine.[1]

Sonographic findings: In frontal plane, we see a complete or incomplete cleft in the center of the vertebral body. Postnatally however, it is easier to confirm diagnosis by MRI.

Differential diagnosis:

? Other vertebral anomalies :

Spina bifida (posteriorly)

Block vertebra (fused vertebrae)

Hemivertebra (failure of development of one side (front/back or lateral of the vertebra)

? Other rare syndromes:[7]

Vertical vertebral body fracture (in adult: seatbelt injury, axial loading)

Spondylothoracic dysplasia (Jacho-Levin syndrome): complex vertebral anomalies with hemi-vertebrae, rib anomalies, and absent vertebral body.

Alagille syndrome (arteriohepatic dysplasia): single or multiple butterfly vertebrae. Rickets due to hepatic disease (postnatal diagnosis).

Aicardi syndrome: butterfly vertebra and other vertebral anomalies, restricted to girls, failure to thrive, “salaam” spasms, hemihypertrophy , partly or completely missing the structure that connects the two sides of the brain (corpus callosum)


Associated anomalies: Butterfly vertebral may be associated with other congenital abnormalities such as anterior spina bifida (with or without anterior meningocele), cardiac abnormalities, forgut abnormalities and spinal diastematomyelia[8][7], neurenteric cysts, anomalies of the lungs, gastrointestinal tract, or genitourinary tract [7] or a part of some rare syndromes: Pfeiffer, Jarcho-Levin, Crousen, Alagille[9], Aicaidi syndrome [7], Goldenhar syndrome.[10]

This anomaly may occur in other syndromes and also in healthy individuals. It is generally not of structural significance.[11][5]12]

Prognosis: The prognosis is related to the presence or absence of associated anomalies. Good prgnosis with isolated butterfly veterbra[13],[1],[5]

Management: An isolated butterfly vertebra does not require treatment.[2][5] The intervention only needs for associated anomalies.

References:

  1. Chris J. Hutcheson, Joseph W. Howe. The low back and pelvis: clinical applications, third volume 1997 ; chapter 3, page 7.
  2. Martin Weyreuther, Christoph E. Heyde, Michael Westphal, Jan Zierski, Ulrich Webe: MRI atlas:orthopedics and neurosurgery : the spine, 2007, chapter 2, 12-16
  3. Charles F. Merbs*, Sagittal Clefting of the Body and Other Vertebra. Developmental Errors in Canadian Inuit Skeletons. American Journal of physical anthropology 2004; 123:236-249
  4. PaulCave: Butterfly Vertebra. British Journal of Radiology (1958) 31, 503-506
  5. Suzanne B.Cassidy, Judith E.Allanson. Management of genetic syndromes. Third edition, 2010, chapter 4. 39-49
  6. Keith L.Moore : The developing human:Clinally oriented embryology.Fourth edition. 1988. Chapter 15:334-348.
  7. Klaus-Dietrich Ebel, Gabriele Benz-Bohm: Differential diagnosis in pediatric radiology, 1999, chapter 6, 616.
  8. R Kumar, FC Guinto, Jr, JE Madewell, LE Swischuk, and R David. The Vertebral Body: Radiographic Configurations in Various Congenital and Acquired Disorders, RadioGraphics , 1988. 8: 455
  9. Birkan Sonel Peyman Yal??n, Erhan Arif ?ztürk, I??k B?kesoy: Butterfly vertebra: A case report, Clinical Imaging Volume 25, Issue 3 2001, 206-208
  10. YK Dastur, H Trivedi, N Tapaswi, N Shah. Godenhar's syndrome with unilateral duane retraction syndrome and "butterfly" vertebra ,1985,Volume 33 Issue : 3 ,P.187-189
  11. Przkora R, Schmitz A, Perlick L, Koenig R, Jaeger U, Schmitt O. Butterfly vertebrae and scoliosis: Alagille syndrome.Z Orthop Ihre Grenzgeb 2002 Mar-Apr;140(2):182-4
  12. Ian D Krantz, David A Piccoli, Nancy B Spinner. Alagille syndrome. J Med Genet. 1997; 34(2): 152–157
  13. Wirginia J. Maixner,Spina Bifida. Management and Outcome 2008. Chapter 14: 186-189.
2012-10-27 09:24
  • 投票 1
  • 收藏
  • 打赏
  • 引用
  • 分享

    • 微信扫一扫

    • 新浪微博
    • 丁香客
    • 复制网址
  • 举报
    • 广告宣传推广
    • 政治敏感、违法虚假信息
    • 恶意灌水、重复发帖
    • 违规侵权、站友争执
    • 附件异常、链接失效
    • 其他
  • • 公立医院、高校附属医院最新急招，均薪 1 万起

关闭提示

需要2个丁当

丁香园旗下网站

  • 丁香园
  • 用药助手
  • 丁香通
  • 文献求助
  • 丁香人才
  • 丁香医生
  • 丁香导航
  • 丁香会议
  • 手机丁香园
  • 医药数据库

关于丁香园

  • 关于我们
  • 丁香园标志
  • 友情链接
  • 联系我们
  • 加盟丁香园
  • 版权声明
  • 资格证书

官方链接

  • 丁香志
  • 丁香园新浪微博
引用回复