Multiple intraosseous cervical pneumatocysts: A case report of a rare incidental finding on cone-beam computed tomography

This report presents a case of cervical pneumatocysts as an incidental finding on cone-beam computed tomography. Pneumatocysts are gas-containing lesions of unknown etiology. They usually present in the ilium or sacrum, adjacent to the sacroiliac joint. In the literature, 21 case reports have described cervical pneumatocysts. Cervical pneumatocysts should be differentiated from other lesions, such as osteomyelitis, osteonecrosis, and neoplasms, as well as post-traumatic and post-surgical cases. Computed tomography, cone-beam computed tomography, and magnetic resonance imaging are appropriate tools to diagnose cervical pneumatocysts.

Neumoquiste vertebral en columna lumbar: reporte de un caso y revisión de la literatura / Vertebral body pneumatocyst in lumbar spine: a case report and review of the literature

Los neumoquistes intraóseos, son lesiones cavitadas de contenido gaseoso, las cuales generalmente son encontradas como hallazgos incidentales en exámenes imagenológicos a nivel sacroiliaco, pubis, sacro, clavícula, cabeza humeral, columna cervical, torácica y en menor medida, en la columna lumbar. La tomografía computarizada es el examen de elección para realizar la confirmación diagnóstica y descartar diagnósticos diferenciales, y su patrón característico se describe como una lesión de aspecto quística con atenuación por gas intralesión con rangos entre -950 y -580 H. El diagnóstico diferencial debe incluir otras posibles causas de gas intraóseo como osteomielitis, osteonecrosis, quistes óseos o subcondrales, entre otros. Si bien la progresión natural del neumoquiste intraoseo es desconocida, distintos autores han descrito que en seguimientos radiológicos hasta 4 años, el tamaño de las lesiones se mantiene estable, e incluso en otros casos se han resuelto de manera espontánea, sin embargo, en otros se ha reportado un crecimiento progresivo en seguimiento de 16 meses. En cuanto al manejo del neumoquiste intraóseo, en la mayoría de los casos reportados se ha observado una evolución benigna, con manejo conservador de las lesiones, sin embargo frente a lesiones de gran tamaño con riesgo de fractura patológica se debe plantear la posibilidad de manejo quirúrgico con corpectomía e injerto óseo. Debido a la escasa evidencia respecto de esa lesión, es que se reporta un caso de neumoquiste vertebral lumbar, describiendo su estudio, evolución y manejo.

The intraosseous pneumatocyst, is a rare condition in which there is gas-filled cystic lesion in the bone which is incidentally discovered on imaging studies and has been observed in relation to iliosacral joint, the humeral head, medial end of the clavicle, cervical spine, and thoracolumbar spine. The computer tomography (CT) is the most useful radiological tool for the diagnosis of the pneumatocyst and the pathognomonic finding is a cystic-like lesion with attenuation that ranges from 950 to 580 Hounsfield units, indicating gas, surrounded by a sclerotic rim. Main differential diagnosis includes other possible causes of intraosseous gas such as infectious osteomyelitis, osteonecrosis, solitary bone cysts, and subchondral cysts. The natural progression of the intraosseous pneumatocyst is unclear. Some authors suggest that these lesions remained unchanged up to 4 years of follow up with CT, and even spontaneous resolution of the pneumatocyst have been reported, but others authors found progressive growth of the lesions in few weeks, months or years. Surgical treatment could be indicated in symptomatic patients or with progressive growth of the lesion at CT follow up that could increase the potential risk of vertebral fracture. We report a case of vertebral body intraosseous pneumoatocyst in lumbar spine describing the diagnosis process and management.

Rapid Resolution of Traumatic Pneumatocyst in the Cervical Spine: A Case Report

Intraosseous pneumatocyst is a benign, gas-filled, cystic lesion, and is commonly encountered in iliac bone or sacrum. Other locations of this lesion following trauma are rare, and only a handful of isolated cases have been reported. The pathogenesis and etiologies of this uncommon entity are various and it can present a diagnostic challenge. Only four previous cases have described the natural course of intravertebral pneumatocysts. Here, the authors report a rare case of traumatic pneumatocyst, which resolved rapidly without further complication. Possible pathogenic mechanisms are discussed and reviews of literatures are included.