Butterfly vertebra

Clinical History

A 15-year-old female patient diagnosed with lymphoma underwent a staging CT.

Imaging Findings

As an incidental finding a sagittal cleft is seen in the vertebral body of T6, consistent with butterfly vertebra. It is the cause of a mild dextroscoliosis. The vertebral bodies above and below the butterfly vertebra adapt to the altered intervertebral discs on either side.

Discussion

Background

Butterfly vertebra, also known as sagittal cleft vertebra, is a rare type of congenital vertebral anomaly that results from the failure of fusion of the lateral halves of the vertebral body because of persistent notochordal tissue between them [1].

Clinical Perspective

Although uncommon, this anomaly is considered to be frequently asymptomatic [2]. It can be associated with syndromes such as Pfeiffer, Jarcho-Levin, Crousen and Alagille [3]. Anterior spina bifida, with or without anterior meningocele, is another possible association [1].

Imaging Perspective

This anomaly is usually seen in the thoracic or lumbar segments of the spine [1].
The affected vertebra has a wide body; it resembles a butterfly and hence its name.
The vertebral bodies above and below the butterfly vertebra usually show concavities along the adjacent endplates, adapting to the altered intervertebral discs on either side.
The defect can be complete such as in the presented case or can be partial, with some bone bridging occurring across the defect [1].

Take Home Message

Knowledge of this entity is important for correct diagnosis, as it may be confused with other pathologic conditions like fractures, infections and metastases [3].

Differential Diagnosis List

Final Diagnosis

Butterfly vertebra - sagittal cleft vertebra

URL:	https://www.eurorad.org/case/14136
DOI:	10.1594/EURORAD/CASE.14136
ISSN:	1563-4086