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Symptomatic Oppenheimer ossicle: a rare mimic of pars interarticularis fracture
Prem P Batchala1, Pankaj Nepal2, Baphiralyne Wankhar3
1Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee Street, Charlottesville, VA 22908, USA.
Abstract:
We report a case of symptomatic Oppenheimer ossicle in an 18-year-old male who presented with back pain. L5 pars interarticularis defect was suspected on initial lumbar spine radiographs. A subsequent technetium99m-methylene diphosphonate (Tc99m-MDP) bone scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) revealed focal radiotracer uptake in an Oppenheimer ossicle in L2 vertebra. CT was negative for pars defect. Oppenheimer ossicle is a developmental variant resulting from an unfused accessory ossification center at the tip of the articular process. It is important to recognize this entity as a rare cause of low back pain. Focal tracer uptake can mimic changes from pars interarticularis defect on planar and SPECT images. SPECT/CT helps to resolve both entities. To our knowledge, this is also the first report in English literature describing a symptomatic Oppenheimer ossicle on a bone scan.
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