Vertebral Collapse Caused by Bone Metastasis

      A 70-year-old woman with multiple sclerosis was hospitalized with diarrhea, fever 38.3°C, and severe midthoracic back pain for 1 week. The patient was paraplegic with complete paralysis and loss of sensation in both legs and lower abdomen. She was diagnosed with a hypernephroma of the right kidney in 1997, for which a nephrectomy was performed. She refused further follow-up.
      On computed tomography scan, invasion of several thoracic vertebrae (Th 4, Th 5, Th 6, and partial Th 7) was seen with a 90° angulation of the proximal dorsal pillar compared with the distal pillar (Figure 1A and B). An extraaxial posterior extension was observed. The lesion was biopsied, performed under echographic control, showing a well-differentiated renal cell metastasis. The bone fragments, anterior of the vertebrae, are believed to be parts of the adjacent ribs (Figure 1B).
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      FIGURE 1A, Sagittal computed tomography (CT) image of the thorax. Bone metastasis caused collapse of the spine. The red arrow points to the chin; the blue arrow points to the hands on the thorax. B, Axial CT image of the thorax. The white arrow shows the destructed vertebral with a lateral shift of the upper thoracic vertebrae.
      Intravenous morphine was administered to help her cope with the pain. The patient died 10 days after computed tomography scan images were taken.