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History

43 yo female s/p fall from standing 5 days prior, now with pelvic pain.

Exam

frontal and lateral views of the lumbosacral spine

Prior Study

none

Dicom

Findings

You scored: 0 / 37

Technique	Correct Answer	Your Answer
The thoracolumbar junction and/or the lumbosacral junction is/are not entirely included on the exam.	No	NA
The exam is over or under penetrated.	Yes	NA
The exam is limited by overlying structures, bones or soft tissues, patient positioning, support devices, or motion.	No	NA

Prevertebral and paravertebral soft tissues	Correct Answer	Your Answer
The prevertebral or paravertebral soft tissues are abnormal.	Yes	NA

Spinal alignment	Correct Answer	Your Answer
The vertebral bodies are abnormally aligned.	No	NA
The anterior and posterior vertebral body lines are abnormal or interrupted.	No	NA
The visualized spinous processes are malaligned or distracted on the AP and/or lateral view(s).	No	NA
There is reversal or straightening of the normal lordosis or scoliosis of the lumbar spine.	No	NA

Vertebral bodies, posterior elements and included sacral segments	Correct Answer	Your Answer
There are more or less than the expected 5 non rib-bearing vertebral bodies.	No	NA
There is a transitional motion segment at the lumbosacral junction (sacralization of L5 or lumbarization of S1).	No	NA
There is a fracture or distraction of a vertebral body, transverse or spinous process, or other posterior element.	No	NA
There is anterior wedging and/or compression of a vertebral body or end plate.	No	NA
There is an end plate avulsion or other fracture.	No	NA
There is displacement of a fracture fragment into the soft tissues or spinal canal.	No	NA
There is lucency or defect of the pars interarticularis from spondylolysis.	No	NA
There is an abnormality of a pedicle or lamina on the frontal or lateral view.	No	NA
There is a fracture, erosion, sclerosis, lytic, or blastic lesion of a pedicle or lamina.	No	NA
There is evidence of a lytic or sclerotic lesion, or disruption of the trabecular pattern of a vertebral body, end plate, or sacrum.	Yes	NA
There is a fracture or interruption of the arcuate lines of the sacrum.	Yes	NA
There is erosion, sclerosis, narrowing, or other abnormality of a sacral foramen or the SI joints.	No	NA
There is focal or diffuse abnormal mineralization of the lumbosacral spine.	Yes	NA

Disc spaces and facet joints	Correct Answer	Your Answer
There is distraction or focal widening of a disc space.	No	NA
There is disc space narrowing with or without erosive or sclerotic changes of the end plates or subchondral bone other than from degenerative change.	No	NA
There is anterior or posterior spondylolisthesis, subluxation, or rotational abnormality at a disc space.	No	NA
There is widening, rotational abnormality, or displacement of facets at any motion segment.	No	NA
There is facet joint narrowing or sclerosis other than from degenerative change.	No	NA
There is narrowing or encroachment of a neural foramen other than from degenerative change.	No	NA
There are degenerative changes present that might explain the patient’s symptoms.	No	NA

Additional soft tissues and bones (lower thorax, abdomen, and pelvis)	Correct Answer	Your Answer
There is abnormal bowel or bowel gas pattern.	No	NA
There are gallstones, vascular, renal, pelvic, or other soft tissue calcifications present.	Yes	NA
There is free intraperitoneal or retroperitoneal air or other abnormal air in the included chest, abdomen, or pelvis.	No	NA
The included thoracic spine, ribs, and remainder of the bony pelvis are abnormal.	Yes	NA
There is abnormality of the lower chest and/or diaphragm.	No	NA
There is a foreign body or there are post surgical changes of the bones or soft tissues of the included lower thorax, abdomen, and pelvis.	No	NA
There is an abnormality or complication of post surgical hardware/device.	NA	NA
There are support lines or tubes in an abnormal position.	No	NA

Other findings	Correct Answer	Your Answer
There are other existing conditions that might be contributing to symptoms which can or should be further evaluated non-emergently.	No	NA

Impression

Expert Answer

There is interruption of the right S1 arcuate line. This could be from an insufficiency fracture. There may be a fracture of the left superior pubic ramus.

Your Answer

Recommendations & Acuity

Recommendations

Expert Answer

Direct communication with the referring physician regarding findings of likely a sacral insufficiency fracture. Recommend cross sectional imaging.

Your Answer

Acuity

Expert Answer

Urgent (Action Necessary in a few hours)

Your Answer

Section 2 CB1247

Findings Results

You scored: 0 / 37

Technique	Correct Answer	Your Answer
The thoracolumbar junction and the lumbosacral junction are included on the exam.	No	NA
The lateral view is under penetrated, but can be adjusted by changing the window settings.	Yes	NA
The exam is not significantly limited by overlying structures, bones or soft tissues, patient positioning, support devices, or motion.	No	NA

Prevertebral and paravertebral soft tissues	Correct Answer	Your Answer
There are vascular calcifications in the prevertebral soft tissues.	Yes	NA

Spinal alignment	Correct Answer	Your Answer
The vertebral bodies are not abnormally aligned.	No	NA
The anterior and posterior vertebral body lines are not abnormal or interrupted.	No	NA
The visualized spinous processes are not malaligned or distracted on the AP or lateral views.	No	NA
There is no reversal or straightening of the normal lordosis or scoliosis of the lumbar spine.	No	NA

Vertebral bodies, posterior elements and included sacral segments	Correct Answer	Your Answer
There are not more or less than the expected 5 non rib-bearing vertebral bodies. The 12th ribs are hypoplastic	No	NA
There is not a transitional motion segment at the lumbosacral junction (sacralization of L5 or lumbarization of S1).	No	NA
There is no fracture or distraction of a vertebral body, transverse or spinous process, or other posterior element.	No	NA
There is no anterior wedging and/or compression of a vertebral body or end plate.	No	NA
There is no end plate avulsion or other fracture.	No	NA
There is no displacement of a fracture fragment into the soft tissues or spinal canal.	No	NA
There is no lucency or defect of the pars interarticularis from spondylolysis.	No	NA
There is no abnormality of a pedicle or lamina on the frontal or lateral view.	No	NA
There is no fracture, erosion, sclerosis, lytic, or blastic lesion of a pedicle or lamina.	No	NA
There is disruption of the trabecular pattern of the right upper sacrum.	Yes	NA
There is a fracture or interruption of the right arcuate line of the S1 segment of the sacrum.	Yes	NA
There is no erosion, sclerosis, narrowing, or other abnormality of a sacral foramen or the SI joints.	No	NA
The bones are osteopenic.	Yes	NA

Disc spaces and facet joints	Correct Answer	Your Answer
There is no distraction or focal widening of a disc space.	No	NA
There is no disc space narrowing with or without erosive or sclerotic changes of the end plates or subchondral bone other than from degenerative change.	No	NA
There is no anterior or posterior spondylolisthesis, subluxation, or rotational abnormality of a disc space.	No	NA
There is no widening, rotational abnormality, or displacement of facets at any motion segment.	No	NA
There is no facet joint narrowing or sclerosis other than from degenerative change.	No	NA
There is no narrowing or encroachment of a neural foramen other than from degenerative change.	No	NA
There are no degenerative changes present that might explain the patient’s symptoms.	No	NA

Additional soft tissues and bones (lower thorax, abdomen, and pelvis)	Correct Answer	Your Answer
There is no abnormal bowel or bowel gas pattern.	No	NA
There are calcifications in the aorta and left iliac artery. There is a phlebolith in the left pelvis.	Yes	NA
There is no free intraperitoneal or retroperitoneal air or other abnormal air in the included chest, abdomen, or pelvis.	No	NA
There may be a fracture of the left superior pubic ramus close to the pubic symphysis.	Yes	NA
There is no abnormality of the lower chest and/or diaphragm.	No	NA
There is no foreign body and there are no post surgical changes of the bones or soft tissues of the included lower thorax, abdomen, and pelvis.	No	NA
There is an abnormality or complication of post surgical hardware/device.	NA	NA
There are no support lines or tubes.	No	NA

Other findings	Correct Answer	Your Answer
There are no other existing conditions that might be contributing to symptoms which can or should be further evaluated non-emergently.	No	NA