A several month history of cervical pain. Plain X-rays showed a discrete lucent lesion.
The patient presented with a history of pain in her neck of several months' duration. Plain radiographs showed degenerative changes of the cervical spine but also a well-defined lytic lesion in the fifth cervical vertebral body (Fig. 1). This raised concern of a lytic metastasis or multiple myeloma. A bone scan showed generalised uptake in the lower cervical spine and lower lumbar spine, but no discrete areas of increased or decreased uptake (Fig. 2). MRI showed that the lesion was of low uptake on T1- and T2-weighted images. CT showed that the lesion contained air: in keeping with a pneumatocyst. Her pain was most likely to be due to degenerative disease.
Intraosseous pneumatocyst (IP) is a relatively rare benign condition which mainly involves the ilium and sacrum around the sacroiliac joints. It is also seen in vertebral bodies usually in close proximity to endplates or facet joints. Other less common sites such as the spinous process, clavicle or humeral head have also been described. It is important to remember that IP is usually asymptomatic and an incidental finding.
IP is seen as a well-defined radiolucent area with sclerotic margin on plain film. On standard radiographs metastasis, multiple myeloma or rarer neoplasms such as osteoblastoma may initially be considered. The thin rim of sclerosis in combination with the diagnosis of gas on CT or MR images lead, as in this case, to the correct diagnosis.
On MRI, IP is seen as areas of low signal on both T1- and T2-weighted sequences. Similar signals can be seen with areas of sclerosis and haemorrhage, both in the acute stage (deoxyhaemoglobin) and later on as haemosiderin. CT is the imaging modality of choice in the diagnosis of IP, showing gas attenuation within a well-defined area surrounded by sclerosis. More than 90% of the gas is nitrogen. Different theories (such as ischaemic changes, extension of an intervetebral vacuum phenomenon, and repeated endplate microfractures) have been suggested with regards to the origin of the IP. However the exact aetiology and natural course is not clearly understood. Recognition of IP is important in order to avoid unnecessary biopsies and follow up.
Pneumatocyst
Based on the provided cervical spine X-ray, MRI, and CT images, a radiolucent lesion with a relatively clear boundary is observed within the cervical vertebral body, surrounded by a thin sclerotic rim. On MRI, this region presents with low signal intensity on both T1- and T2-weighted sequences. CT demonstrates gas density (negative values or values close to those of gas attenuation), consistent with a typical air-filled lesion within the vertebral body (intraosseous pneumatocyst). There is no marked infiltration or destructive change in the surrounding bone, and no obvious abnormalities are found in the adjacent intervertebral discs or paravertebral soft tissues.
Considering the patient’s age, several months of neck pain, and imaging findings of a gas-containing vertebral lesion with a thin sclerotic rim, without significant destruction or invasive features, the most likely diagnosis is Intraosseous Pneumatocyst (IP). This entity is typically benign and does not require additional invasive testing. If doubts persist or symptoms worsen, periodic imaging follow-up is advised to rule out other potential malignancies.
Specific treatment for intraosseous pneumatocyst is usually not necessary. If symptoms are mild or associated with other degenerative cervical conditions, conservative management and rehabilitation exercises may be considered.
Surgical or interventional treatment may be considered if there is a significant risk of fracture, neurological compression, or a suspicion of malignancy. In most cases, simple IP does not require surgical intervention.
Throughout the entire rehabilitation process, it is recommended to follow the FITT-VP principle (Frequency, Intensity, Time, Type, Volume, and Progression). Adjust exercise modalities and intensity according to the individual’s condition, especially in cases of bone fragility or compromised cardiopulmonary function. Professional guidance is essential to ensure safety.
Disclaimer: This report is for reference only and cannot replace a face-to-face consultation or professional medical advice. Please seek prompt medical evaluation if you experience severe discomfort or changes in your condition.
Pneumatocyst
