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Radiographic Normal Variants

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Pitfalls in Musculoskeletal Radiology
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Abstract

A “normal variant” is defined as an incidental, usually asymptomatic, imaging finding that simulates true pathology. Given the nearly limitless spectrum of skeletal variation, a solid understanding of commonly encountered normal radiographic variants is essential to avoid mistaking one for true pathology. Similarly, a familiarity with those “normal” variants that are known to, at times, become symptomatic is essential to help direct further work-up when the clinical findings are suggestive of a potentially painful variant.

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References

  • Ajmal M, O’Rourke SK (2005) Odontoid lateral mass interval (OLMI) asymmetry and rotary subluxation: a retrospective study in cervical spine injury. J Surg Orthop Adv 14:23–26

    CAS  PubMed  Google Scholar 

  • Anwar R, Anjum SN, Nicholl JE (2005) Sesamoids of the foot. Curr Orthop 19:40–48

    Article  Google Scholar 

  • Arvan B, Fournier-Gosselin MP, Fehlings MG (2010) Os odontoideum: etiology and surgical management. Neurosurgery 66:A22–A31

    Article  Google Scholar 

  • Bernaerts A, Vanhoenacker FM, Van de Perre S et al (2004) Accessory navicular bone: not such a normal variant. JBR-BTR 87:250–252

    CAS  PubMed  Google Scholar 

  • Billmann F, Bokor-Billmann T, Burnett C et al (2013) Occurrence and significance of odontoid lateral mass interspace asymmetry in trauma patients. World J Surg 37:1988–1995

    Article  PubMed  Google Scholar 

  • Carr RB, Tozer Fink KR, Gross JA (2012) Imaging of trauma: part 1, pseudotrama of the spine – osseous variants that may simulate injury. AJR Am J Roentgenol 199:1200–1206

    Article  PubMed  Google Scholar 

  • Cushing KE, Ramesh V, Gardner-Medwin D et al (2001) Tethering of the vertebral artery in the congenital arcuate foramen of the atlas vertebra: a possible cause of vertebral artery dissection in children. Dev Med Child Neurol 43:491–496

    Article  CAS  PubMed  Google Scholar 

  • Dai L, Yuan W, Ni B et al (2000) Os odontoideum: etiology diagnosis and management. Surg Neurol 53:106–109

    Article  CAS  PubMed  Google Scholar 

  • Dar G, Masharawi Y, Peleg S et al (2010) Schmorl’s nodes distribution in the human spine and its possible etiology. Eur Spine J 19:670–675

    Article  PubMed  Google Scholar 

  • Doukas A, Petridis AK (2010) A case of aplasia of the posterior arch of the atlas mimicking fracture: review of the literature. Clin Anat 23:881–882

    Article  PubMed  Google Scholar 

  • Fidas A, McDonald HL, Elton RA et al (1987) Prevalence and patterns of spina bifida occulta in 2707 normal adults. Clin Radiol 38:537–542

    Article  CAS  PubMed  Google Scholar 

  • Freyschmidt J, Brossmann J, Wiens J, Sternberg A (eds) (2003) Borderlands of normal and early pathological findings in skeletal radiography. Thieme, New York

    Google Scholar 

  • Gaca AM, Barnhart HX, Bisset GS (2010) Evaluation of wedging of lower thoracic and upper lumbar vertebral bodies in the pediatric population. AJR Am J Roentgenol 194:516–520

    Article  PubMed  Google Scholar 

  • Gantopadhyay S, Aslam M (2003) Posterior arch defects of the atlas: significance in trauma and literature review. Eur J Emerg Med 10:238–240

    Article  Google Scholar 

  • Gheorghiu D, Leinekkugel A (2010) The linea aspera-pilaster complex as a possible cause of confusion with the ‘flame sign’: a case report. Acta Orthop Traumatol Turc 44:254–256

    Article  PubMed  Google Scholar 

  • Helms CA (1978) Pseudocysts of the humerus. AJR Am J Roentgenol 131:287–288

    Article  CAS  PubMed  Google Scholar 

  • Henales V, Hervas JA, Lopez P et al (1993) Intervertebral disc herniations (limbus vertebrae) in pediatric patients: report of 15 cases. Pediatr Radiol 23:608–610

    Article  CAS  PubMed  Google Scholar 

  • Ho VB, Kransdorf MJ, Jelinek JS et al (1991) Dorsal defect of the patella: MR feature. J Comput Assist Tomogr 15:474–476

    Article  CAS  PubMed  Google Scholar 

  • Hoeffel C, Munier G, Hoeffel JC (1993) The femoral linea aspera: radiological pattern. Eur Radiol 3:357–358

    Article  Google Scholar 

  • Huang MJ, Glaser JA (2003) Complete arcuate foramen precluding C1 lateral mass screw fixation in a patient with rheumatoid arthritis: case report. Iowa Orthop J 23:96–99

    PubMed  PubMed Central  Google Scholar 

  • Jaremko JL, Siminoski K, Firth GB et al (2015) Common normal variants of pediatric vertebral development that mimic fractures: a pictorial review from a national longitudinal bone health study. Pediatr Radiol 454:593–605

    Article  Google Scholar 

  • Karasick D, Schweitzer ME (1996) The os trigonum syndrome: imaging features. AJR Am J Roentgenol 166:125–129

    Article  CAS  PubMed  Google Scholar 

  • Karasick D, Schweitzer ME (1998) Disorders of the hallux sesamoid complex: MR features. Skeletal Radiol 24:411–418

    Google Scholar 

  • Kavanagh EC, Zoga A, Omar I et al (2007) MRI findings in bipartite patella. Skeletal Radiol 36:209–214

    Google Scholar 

  • Keats TE, Anderson MW (eds) (2013) Atlas of normal roentgen variants that may simulate disease, 9th edn. Philadelphia, Elsevier

    Google Scholar 

  • Lawson JP (1994) Clinically significant radiologic anatomic variants of the skeleton. AJR Am J Roentgenol 163:249–255

    Article  CAS  PubMed  Google Scholar 

  • Lee S, Joyce S, Seeger J (1986) Asymmetry of the odontoid-lateral mass interspaces: a radiographic finding of questionable clinical significance. Ann Emerg Med 15:1173–1176

    Article  CAS  PubMed  Google Scholar 

  • Masharawi Y, Salame K, Mirovsky Y et al (2008) Vertebral body shape variation in the thoracic spine: characterization of its asymmetry and wedging. Clin Anat 21:46–54

    Article  PubMed  Google Scholar 

  • Matsumoto M, Okada E, Kaneko Y et al (2011) Wedging of vertebral bodies at the thoracolumbar junction in asymptomatic healthy subjects on magnetic resonance imaging. Surg Radiol Anat 33:223–228

    Article  PubMed  Google Scholar 

  • Mellado JM, Ramos A, Salvado E et al (2003) Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis. Eur Radiol 13:L164–L177

    Article  Google Scholar 

  • Miller TT, Staron RB, Feldman F et al (1995) The symptomatic accessory tarsal navicular bone: assessment with MR imaging. Radiology 195:849–853

    Article  CAS  PubMed  Google Scholar 

  • Mosel LD, Kat E, Voyvodic F (2004) Imaging of the symptomatic type II accessory navicular bone. Australas Radiol 48:267–271

    Article  PubMed  Google Scholar 

  • Nault M-L, Kocher MS, MIcheli LJ (2014) Os trigonum syndrome. J Am Acad Orthop Surg 22:545–553

    Article  PubMed  Google Scholar 

  • Nguyen MS, Kheyfits V, Giordano BD et al (2013) Hip anatomic variants that may mimic pathologic entities on MRI: nonlabral variants. AJR Am J Roentgenol 201:W401–W408

    Article  PubMed  Google Scholar 

  • Oohashi Y, Koshino T, Oohashi Y (2010) Clinical features and classification of bipartite or tripartite patella. Knee Surg Sports Traumatol Arthrosc 18:1465–1469

    Article  PubMed  Google Scholar 

  • Perdikakis E, Grigoraki E, Karantanas A (2011) Os naviculare: the multi-ossicle configuration of a normal variant. Skeletal Radiol 40:85–88

    Google Scholar 

  • Pfirrmann CW, Resnick D (2001) Schmorl nodes of the thoracic and lumbar spine: radiographic-pathologic study of prevalence, characterization, and correlation with degenerative changes of 1,650 spinal levels in 100 cadavers. Radiology 219:368–374

    Article  CAS  PubMed  Google Scholar 

  • Sammarco VJ (2000) Os acromiale: frequency, anatomy, and clinical implications. J Bone Joint Surg Am 82:394–400

    Article  CAS  PubMed  Google Scholar 

  • Sankar WN, Wills BPD, Dormans JP et al (2006) Os odontoideum revisited: the case for a multifactorial etiology. Spine 31:979–984

    Article  PubMed  Google Scholar 

  • Smoker WRK (1994) Craniovertebral junction: normal anatomy, craniometry, and congenital anomalies. Radiographics 14:255–277

    Article  CAS  PubMed  Google Scholar 

  • Sobel M, Pavlov H, Geppert MJ et al (1994) Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain. Foot Ankle Int 15:112–124

    Article  CAS  PubMed  Google Scholar 

  • Stabler A, Belian M, Weiss M et al (1997) MR imaging of enhancing intraosseous disk herniation (Schmorl’s nodes). AJR Am J Roentgenol 168:933–938

    Article  CAS  PubMed  Google Scholar 

  • Stubbs DM (1992) The arcuate foramen. Variability in distribution related to race and sex. Spine 17:1502–1504

    Article  CAS  PubMed  Google Scholar 

  • Sutherland JP, Yaszemski MJ, White AA (1995) Radiographic appearance of the odontoid lateral mass interspace in the occiptoatlantoaxial complex. Spine 20:2221–2225

    Article  PubMed  Google Scholar 

  • Swishchuk LE, John SD, Allbery S (1998) Disk degenerative disease in childhood: Scheuermann’s disease, Schmorl’s nodes, and the limbus vertebra: MRI findings in 12 patients. Pediatr Radiol 28:334–338

    Article  Google Scholar 

  • Van Holsbeeck M, Vandamme B, Marchal G et al (1987) Dorsal defect of the patella: concept of its origin and relationship with bipartite and multipartite patella. Skeletal Radiol 16:304–311

    Google Scholar 

  • Wagner AL, Murtagh FR, Arrington JA et al (2000) Relationship of Schmorl’s nodes to vertebral body endplate fractures and acute endplate disk extrusions. AJNR Am J Neuroradiol 21:276–281

    CAS  PubMed  Google Scholar 

  • Walters G, Coumas JM, Akins CM et al (1991) Magnetic resonance imaging of acute symptomatic Schmorl’s node formation. Pediatr Emerg Care 7:294–296

    Article  CAS  PubMed  Google Scholar 

  • Wang XT, Rosenberg ZS, Mechlin MB et al (2005) Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features. Radiographics 25:587–602

    Article  PubMed  Google Scholar 

  • Zander G (1943) Os acetabuli and other bone nuclei; periarticular calcifications at the hip joint. Acta Radiol 24:317–327

    Article  Google Scholar 

  • Zhang Z, Zhou Y, Wang J et al (2010) Acute traumatic cervical cord injury in patients with os odontoideum. J Clin Neurosci 17:1289–1293

    Article  PubMed  Google Scholar 

Download references

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Correspondence to Mark W. Anderson MD .

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Anderson, M.W. (2017). Radiographic Normal Variants. In: Peh, W. (eds) Pitfalls in Musculoskeletal Radiology. Springer, Cham. https://doi.org/10.1007/978-3-319-53496-1_11

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  • DOI: https://doi.org/10.1007/978-3-319-53496-1_11

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