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LETTER TO EDITOR
Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1705-1707

Intraosseous Cervical Pneumatocyst


Department of Neuroimaging and Interventional Neuroradiology, All india Institute of Medical Sciences, New Delhi, India

Date of Submission04-Mar-2019
Date of Decision13-Mar-2019
Date of Acceptance13-Apr-2020
Date of Web Publication30-Aug-2022

Correspondence Address:
Ajay Garg
Department of Neuroimaging and Interventional Neuroradiology, Cathlab Complex, Neurosciences Centre, All India Institute of Medical Sciences, Room No 14, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.355111

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How to cite this article:
Gupta MM, Nayak MK, Prabhakar A, Garg A. Intraosseous Cervical Pneumatocyst. Neurol India 2022;70:1705-7

How to cite this URL:
Gupta MM, Nayak MK, Prabhakar A, Garg A. Intraosseous Cervical Pneumatocyst. Neurol India [serial online] 2022 [cited 2022 Oct 2];70:1705-7. Available from: https://www.neurologyindia.com/text.asp?2022/70/4/1705/355111


Sir,

We report an interesting case of a 57-year-old man who underwent for magnetic resonance imaging (MRI) of the cervical spine for evaluation of neck pain. Degenerative spondylotic changes were present on MR without narrowing of neural foramina or cord compression. In addition, well-defined hypointense areas were seen in posterior half of C4 and C5 vertebral bodies in both T1-WI and T2-WI [Figure 1]. To further characterize these areas of low signal intensity, a computed tomography (CT) of the cervical spine was performed. CT images showed well-circumscribed non-expansile low attenuation areas having air (HU~ −876) density within the posterior halves of C4 and C5 vertebral bodies [Figure 2]. The cortical margins were intact with degenerative changes in cervical spine. Based on these imaging findings a diagnosis of intravertebral pneumatocyst was made.
Figure 1: MRI (a) Sag T1W, (b) Sag T2W images of cervical spine reveal well-defined foci of low signal intensity within C4 and C5 vertebral bodies (arrows) with degenerative changes in cervical spine

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Figure 2: CT images in sagittal (a) and axial (b and c) planes shows lucent foci containing air (HU~ −876) (arrow; a) within C4 and C5 vertebral bodies. The axial CT (b and c) images show well circumscribed non-expansile low attenuation foci (arrows; b and c) within C4 and C5 vertebral bodies consistent with air. The cortical margins are intact with degenerative changes in cervical spine

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An intravertebral pneumatocysts are rare air-containing cysts discovered incidentally on imaging. They are usually asymptomatic. Although they are rarely reported in the cervical spine, recent studies have shown that these lesion may be more common than previously thought.[1] Cervical vertebral pneumatocysts most commonly occur in the posterolateral corner of the vertebral body. They may also form in the spinous process or the lateral mass. Most are small and subcentimetric in size, but some may be large or multiple. They may or may not communicate with the adjacent discs, joint-spaces or the spinal canal.[2] The pathogenesis of these cysts is not clear. They have been proposed to either develop spontaneously or from vacuum degeneration of pre-existing intraosseous ganglia/synovial cysts. Pneumatocysts may also develop from extension of gas from degenerating cervical discs through adjoining endplates or from other joints.[2] Various pathological conditions like gas-forming osteomyelitis, osteonecrosis, trauma, and surgery have also been implicated in formation of air foci within the vertebral body.[3]

The natural history of cervical pneumatocysts is variable and unclear. Though most pneumatocysts retain their size and appearance over years on imaging, some may gradually increase in size while others may progress spontaneously to fluid-filled cysts and later replacement by granulation tissue.[2] Typically no treatment is required; surgical treatment may be necessary only if a cyst becomes large enough to occupy most of the vertebral body as this may increase the risk of fracture. A brief review of the important literature is presented in [Table 1].
Table 1: Review of literature

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Pneumorrhachis, which is air within spinal canal, has been reported in both subarachnoid space and epidural spaces. The most common causes are trauma and iatrogenic injuries.[4],[5] However, in our case, the air foci were present within the vertebral bodies and not within the spinal canal. In conclusion, vertebral pneumaocysts are a rare benign finding that may be mistaken for sclerotic meatstases or enotosis on MRI. Demonstration of intralesional gas (HU~ −580 to − 950) by CT scan is confirmatory for diagnosis.[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Matsukubo Y, Kashiwagi N, Uemura M, Tatsumi S, Takahashi H, Hyodo T, et al. Intravertebral pneumatocysts of the cervical spine. Neuroradiology 2013;55:1341–4.  Back to cited text no. 1
    
2.
Yamamoto T, Yoshiya S, Kurosaka M, Nagira K, Takabatake M, Hamamoto H, et al. Natural course of an intraosseous pneumatocyst of the cervical spine. Am J Roentgenol 2002;179:667–9.  Back to cited text no. 2
    
3.
Fitzek S, Engelmann C, Fitzek C. Vertebral pneumatization. Clin Neuroradiol 2011;21:27–30.  Back to cited text no. 3
    
4.
Dolgun H, Gurer B, Sari O, Sekerci Z. Isolated subarachnoid pneumorrhachis. Neurol India 2011;59:139–41.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Bellil M, Hadhri K, Tebourbi A. Cervical pneumorrhachis secondary to a basal skull fracture. Neurol India 2015;63:800–1.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Arslan G, Çeken K, Çubuk M, Özkaynak C, Lüleci E. Vertebral pneumatocysts. Acta Radiologica 2001;42:20–3.  Back to cited text no. 6
    
7.
Nakayama T, Ehara S, Hama H. Spontaneous progression of vertebral intraosseous pneumatocysts to fluid-filled cysts. Skeletal Radiol 2001;30:523–6.  Back to cited text no. 7
    
8.
Al-Tarawneh E, AL-Qudah M, Hadidi F, Jubouri S, Hadidy A. Incidental intraosseous pneumatocyst with gas-density-fluid level in an adolescent: A case report and review of the literature. J Radiol Case Rep 2014;8:16–22.  Back to cited text no. 8
    
9.
Haithcock JA, Layton KF, Opatowsky MJ. Vertebral pneumatocysts: Uncommon lesions with pathognomonic imaging characteristics. Bayl Univ Med Cent Proc 2006;19:423–4.  Back to cited text no. 9
    
10.
Cofiar M, Eser O, Aslan A, Korkmaz S, Boyaci G, De B, et al. Servikal Omurda Yerleflik Pnömatokist ve Literatürün Gözden Geçirilmesi. Turk Neurosurg 2008;18:197–99.  Back to cited text no. 10
    
11.
Zarei F, Iranpour P. Pneumatocyst, mimicking a sclerotic bony lesion on magnetic resonance imaging. Spine J 2010;10:e17–9.  Back to cited text no. 11
    
12.
Hoover JM, Wenger DE, Eckel LJ, Krauss WE. Cervical pneumatocyst. J Neurosurg Spine 2011;15:332–5.  Back to cited text no. 12
    
13.
Wilkinson VH, Carroll T, Hoggard N. Contrasting natural histories of thoracic spine pneumatocysts: Resolution versus rapid enlargement. Br J Radiol 2011;84:e79–82.  Back to cited text no. 13
    
14.
You SK, Lee IH, Song CJ, Hwang HY. Spontaneous enlargement of intraosseous pneumatocyst in the cervical spine. Eur J Radiol Extra 2011;78:e133–4.  Back to cited text no. 14
    
15.
Husain MA, Tetradis S, Mallya SM. Intraosseous pneumatocysts of the cervical spine: A report of four cases and review of literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2015;119:e49–54.  Back to cited text no. 15
    
16.
Renshaw H, Patel A, Boctor DSZM, Hakmi MA. 'Abnormal' cervical imaging?: Cervical pneumatocysts – A case report of a cervical spine pneumatocyst. J Orthop 2015;12:S83–5.  Back to cited text no. 16
    
17.
Sen D, Satija L, Saxena S, Rastogi V, Singh M. Intraosseous pneumatocyst of the cervical vertebra. Med J Armed Forces India 2015;71:380–3.  Back to cited text no. 17
    
18.
Di Carlo S, Stissi V, Asnaghi R, Massazza G, Ferriero G. Pneumatocysts in elderly adults: A black hole in neck pain. J Am Geriatr Soc 2016;64:233–4.  Back to cited text no. 18
    
19.
Jadhav AB, Sarah SG, Cederberg R, Wagh A, Kiat-amnuay S. Multiple intraosseous cervical pneumatocysts: A case report of a rare incidental finding on cone-beam computed tomography. Imag Sci Dentistry 2018;48:223–6.  Back to cited text no. 19
    


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