Spot Diagnosis

One Too Many Bones

Margarida Almendra1, Vera Brites1, Pedro António Jordão2, João Falcão Estrada1
1Pediatric Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, 2Orthopedics Department, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE

Address for Correspondence: Maria Margarida dos Reis Gomes Almendra, Hospital Dona Estefânia, Rua Jacinta Marto, 1169-045 Lisbon, Portugal.
Keywords : Sprengel deformity, Klippel-Feil Syndrome, shoulder asymmetry, omovertebral bone
Question :
A 6-year-old girl with a personal history of global development delay, epilepsy and cardiopathy was referred to the Orthopaedic Department due to shoulder asymmetry. She complained of functional limitation in daily activities, no pain registered and, recently, frequent falls with lower extremity weakness. On physical examination, the left shoulder and scapula were at a higher level and limited abduction was noted on the left shoulder. Spine x-ray revealed toraco-lombar scoliosis. Cervical computed tomography (CT) and magnetic resonance with three-dimensional reconstruction revealed multiple vertebral malformations and an omovertebral bone that runs from the superior internal border of the scapula to the posterior arch of C6 (Figure 1). She required a surgery were an 8 cm omovertebral bone exeresis was performed, without complications. On follow-up, neurologic symptoms resolved and the patient described no pain and improved shoulder abduction mobility and cosmetics.

Figure 1. 3D Cervical CT scan.
<b>Figure 1.</b> 3D Cervical CT scan.

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