Images in Clinical Rheumatology
Butterfly Vertebra
Vértebra en mariposa
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MRI showing, in the sagittal T1-weighted sequence, anterior wedging similar to that seen on the radiograph (B, arrow), but the coronal sections show that it actually corresponded to a defect in the fusion of the vertebral body, which originated the presence of 2 hemivertebrae, the right slightly smaller than the left, with the typical appearance of a “butterfly vertebra” (C, arrowheads).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A female 62-year-old patient was diagnosed with osteoporotic compression fractures at the D10 level and referred to a tertiary center for study and initiation of antiresorptive therapy. She reported her menarche at age 15 and menopause at age 45. She had a calcium intake over 1000<span class="elsevierStyleHsp" style=""></span>mg/day, as well as adequate sun exposure and physical activity, and had no history of previous fractures, thyroid disease or urolithiasis. She had recently been diagnosed with hypercholesterolemia and received simvastatin, but denied using other drugs. The vertebral collapse was assumed to be asymptomatic as there was no pain or a history of previous trauma. On examination, her height was 147<span class="elsevierStyleHsp" style=""></span>cm, and she weighed 58<span class="elsevierStyleHsp" style=""></span>kg (BMI 26), and presented mild thoracolumbar kyphosis with left convexity scoliosis but the spinal mobility and neurological examination were normal. Laboratory tests, including calcium, phosphorus, parathyroid hormone, thyrotropin, 25 (OH) vitamin D3, calciuria and tubular reabsorption of phosphate, were normal. Densitometry showed spinal (<span class="elsevierStyleItalic">T</span> score: −2.8) and femoral neck osteoporosis (<span class="elsevierStyleItalic">T</span> score: −3.2). A lateral spine X-ray showed an apparent severe anterior vertebral collapse at D10, but magnetic resonance imaging (MRI) revealed that this actually corresponded to a typical ‘butterfly vertebra’ (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The patient was diagnosed with densitometric osteoporosis and the onset of antiresorptive therapy was postponed.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Butterfly vertebra (also known as vertebral sagittal cleft, anterior rachischisis, somatoschysis, spina bifida or above)<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> is a rare congenital malformation caused by the failure of fusion of the lateral chondrification nuclei of vertebrae developing,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> secondary to incomplete embryological regression originating in the notochordal sagittal funnel shaped groove into the vertebral body, through which the adjacent vertebral discs<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> are connected. This defect occurs between the third and sixth weeks of gestation<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> and is located most frequently at<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> the lumbar level. It is associated with other congenital abnormalities such as Mullerian hypo/aplasia and Jarcho-Levin, Pfeiffer, Crouzon, Alagille and Kallmann syndromes, although it can also occur in isolation.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,7,8</span></a> Patients are usually asymptomatic and this malformation is usually detected incidentally, but it may alter the biomechanics of the spine causing atypical back pain or increasing the chance of disk herniation.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> The lateral X-rays show a trapezoidal or anterior cuneiform morphology, so it may be confused with osteoporotic vertebral collapse or other pathological vertebral fractures, including traumatic, infectious or metastatic ones.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,7,9</span></a> The wedging is caused by anterior hypo/aplasia due to a congenital deficiency of vascularization.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,9</span></a> In the anteroposterior radiograph it is easily detected because the vertebra is divided into two hemivertebrae (usually symmetrical, but may be of different size conditioning scoliosis), which look like the wings of a butterfly,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,4</span></a> although this X-ray image was not seen in our case. CT and MRI are recommended in doubtful cases or to exclude other associated congenital anomalies such as vertebral bars, supernumerary lumbar vertebrae, spina bifida, kyphoscoliosis or diastematomielia.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The use of three-dimensional fetal ultrasonography has been recently described for the prenatal diagnosis of butterfly vertebra.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In conclusion, although butterfly vertebra is uncommon, it should be considered in the differential diagnosis of osteoporotic compression fractures.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Responsibilities</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of people and animals</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that this research has not performed experiments on humans or animals.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace regarding the publication of data from patients and all patients included in the study have received sufficient information and gave written informed consent to participate in the study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors have obtained informed consent from patients and/or subjects referred to in the article. This document is in the possession of the corresponding author.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of Interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-07-31" "fechaAceptado" => "2014-01-08" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sifuentes Giraldo WA, Gallego Rivera JI, Vázquez Díaz M. Vértebra en mariposa. Reumatol Clin. 2015;11:52–53.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 997 "Ancho" => 1501 "Tamanyo" => 192210 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lateral X-ray of the thoracic spine showing apparent anterior wedge compression fractures at the D10 level (A, arrow). MRI showing, in the sagittal T1-weighted sequence, anterior wedging similar to that seen on the radiograph (B, arrow), but the coronal sections show that it actually corresponded to a defect in the fusion of the vertebral body, which originated the presence of 2 hemivertebrae, the right slightly smaller than the left, with the typical appearance of a “butterfly vertebra” (C, arrowheads).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 429 "Ancho" => 1301 "Tamanyo" => 88486 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MRI axial images obtained at the D10 level with T1 (A) and T2 (B) potentiated sequences, confirming the presence of the above defect, with unaffected laminae and pedicles, and no spinal canal compression.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Butterfly vertebra anomaly: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 18 | 8 | 26 |
| 2024 October | 435 | 59 | 494 |
| 2024 September | 547 | 48 | 595 |
| 2024 August | 664 | 71 | 735 |
| 2024 July | 454 | 63 | 517 |
| 2024 June | 367 | 45 | 412 |
| 2024 May | 342 | 61 | 403 |
| 2024 April | 211 | 40 | 251 |
| 2024 March | 269 | 40 | 309 |
| 2024 February | 384 | 42 | 426 |
| 2024 January | 567 | 22 | 589 |
| 2023 December | 467 | 27 | 494 |
| 2023 November | 505 | 33 | 538 |
| 2023 October | 663 | 43 | 706 |
| 2023 September | 603 | 44 | 647 |
| 2023 August | 551 | 32 | 583 |
| 2023 July | 474 | 35 | 509 |
| 2023 June | 438 | 29 | 467 |
| 2023 May | 454 | 30 | 484 |
| 2023 April | 411 | 9 | 420 |
| 2023 March | 519 | 43 | 562 |
| 2023 February | 425 | 37 | 462 |
| 2023 January | 343 | 15 | 358 |
| 2022 December | 296 | 35 | 331 |
| 2022 November | 377 | 60 | 437 |
| 2022 October | 384 | 47 | 431 |
| 2022 September | 425 | 36 | 461 |
| 2022 August | 374 | 54 | 428 |
| 2022 July | 309 | 50 | 359 |
| 2022 June | 294 | 44 | 338 |
| 2022 May | 289 | 52 | 341 |
| 2022 April | 326 | 53 | 379 |
| 2022 March | 340 | 59 | 399 |
| 2022 February | 320 | 47 | 367 |
| 2022 January | 367 | 51 | 418 |
| 2021 December | 302 | 42 | 344 |
| 2021 November | 253 | 59 | 312 |
| 2021 October | 293 | 77 | 370 |
| 2021 September | 273 | 50 | 323 |
| 2021 August | 215 | 48 | 263 |
| 2021 July | 252 | 43 | 295 |
| 2021 June | 255 | 54 | 309 |
| 2021 May | 208 | 46 | 254 |
| 2021 April | 507 | 131 | 638 |
| 2021 March | 217 | 29 | 246 |
| 2021 February | 173 | 26 | 199 |
| 2021 January | 132 | 26 | 158 |
| 2020 December | 128 | 28 | 156 |
| 2020 November | 91 | 27 | 118 |
| 2020 October | 61 | 14 | 75 |
| 2020 September | 87 | 33 | 120 |
| 2020 August | 51 | 17 | 68 |
| 2020 July | 49 | 37 | 86 |
| 2020 June | 41 | 25 | 66 |
| 2020 May | 48 | 25 | 73 |
| 2020 April | 45 | 16 | 61 |
| 2020 March | 17 | 11 | 28 |
| 2020 February | 1 | 0 | 1 |
| 2018 May | 15 | 0 | 15 |
| 2018 April | 150 | 14 | 164 |
| 2018 March | 172 | 19 | 191 |
| 2018 February | 108 | 7 | 115 |
| 2018 January | 132 | 6 | 138 |
| 2017 December | 113 | 4 | 117 |
| 2017 November | 111 | 12 | 123 |
| 2017 October | 83 | 4 | 87 |
| 2017 September | 89 | 13 | 102 |
| 2017 August | 126 | 18 | 144 |
| 2017 July | 101 | 27 | 128 |
| 2017 June | 116 | 52 | 168 |
| 2017 May | 151 | 20 | 171 |
| 2017 April | 91 | 18 | 109 |
| 2017 March | 144 | 59 | 203 |
| 2017 February | 160 | 18 | 178 |
| 2017 January | 98 | 12 | 110 |
| 2016 December | 116 | 21 | 137 |
| 2016 November | 164 | 15 | 179 |
| 2016 October | 181 | 25 | 206 |
| 2016 September | 230 | 19 | 249 |
| 2016 August | 241 | 11 | 252 |
| 2016 July | 97 | 7 | 104 |
| 2016 June | 1 | 0 | 1 |
| 2016 April | 1 | 0 | 1 |
| 2016 March | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 2 | 0 | 2 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 74 | 10 | 84 |
| 2015 June | 95 | 21 | 116 |
| 2015 May | 109 | 25 | 134 |
| 2015 April | 123 | 16 | 139 |
| 2015 March | 140 | 18 | 158 |
| 2015 February | 124 | 15 | 139 |
| 2015 January | 56 | 13 | 69 |
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