Case report 709: Transverse fracture with epidural and small paravertebral hematomata, in a patient with ankylosing spondylitis.

This case demonstrates the potential pitfall of obtaining CT images in the axial plane alone, with a fracture parallel to the imaging plane mimicking vertebral body destruction and associated epidural mass mimicking neoplasm. Chan et al. have discussed the value of reformatted CT images in coronal and sagittal planes to define better transverse vertebral fractures. The case also demonstrates the potential danger of bypassing plain radiographs with the aim of facilitating a rapid diagnosis. Plain films, performed in this case only after CT myelography, clearly demonstrated a transverse pathological fracture in an ankylosed spine with no evidence of neoplastic destruction, enabling easy diagnosis of SEH on the CT appearance. The delayed onset of neurological deficit after fracture reinforces the importance of education of the patient with AS. This principally involves altering patients to the fragility of their spine and to the importance of avoiding spinal trauma. However, patients with known AS should be warned to seek medical advice after even minor spinal trauma with the aim of minimizing the incidence of delayed neurological complications such as occurred in this patient.