Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Kümmell Disease


KEY FACTS

Terminology

  • Posttraumatic avascular necrosis of vertebral body

Imaging

  • Radiographs, CT

    • Loss of height, sclerosis of vertebral body

    • Narrow, horizontally oriented band of gas in vertebral body

    • Filling cleft in vertebral body due to fracture nonunion

  • MR

    • Vertebral body collapse

    • Gas-filled cleft is low signal intensity on all sequences (unless fluid-filled)

    • Fracture line may or may not be visible

    • Less well seen than on CT scan

Top Differential Diagnoses

  • Infection

  • Nontraumatic bone infarction

  • Gas within degenerated intervertebral discs

  • Calcium pyrophosphate dihydrate deposition

Pathology

  • Radiographically occult vertebral body clefts common in patients with fracture

  • Nonunited vertebral body fracture cleft undergoes 2° necrosis, collapse

  • Nitrogen accumulates in fracture cleft

Clinical Issues

  • Presents with pain, kyphosis

  • Usually occurs in elderly, osteoporotic patients

  • Progressive vertebral body collapse if untreated

Diagnostic Checklist

  • Kümmell disease may be rarely associated with pathologic fracture

Coronal bone CT shows gas within a collapsed, sclerotic vertebral body. Gas is also present in the adjacent disc spaces . The gas seen in Kümmell disease probably migrates into the vertebral body from a degenerated disc.

Sagittal T1WI MR shows gas in an osteoporotic burst fracture and adjacent discs . Gas could easily be mistaken for calcification on the MR.

Sagittal T2WI MR reveals band-like gas in the vertebral body and gas in the intervertebral discs . The findings are less conspicuous and less specific than demonstrated with bone CT.

Sagittal bone CT shows gas in a collapsed vertebral body. This unusual case has occurred in a patient with metastatic disease . Kümmell disease should not be presumed to always indicate a benign compression fracture. This patient had blastic metastases from prostate carcinoma.

TERMINOLOGY

Definitions

  • Posttraumatic avascular necrosis of vertebral body

IMAGING

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts