PMC2684975_01
A. General appearance of the patient with hypoplasia of the right thumb, and asymmetry of the chest wall and shoulders.. B. Volume rendering three-dimensional CT lateral cervical image showing the fusion (arrow) of the vertebral bodies and the posterior elements of C2-C4 with the wasp-waist sign.. C. Volume rendering three-dimensional CT sagittal cervical image showing the fusion (arrows) of C2-4 and T1-2 (arrow).. D. Volume rendering three-dimensional CT chest image showing bilateral cervical ribs (arrows) at the level of C7.. E. Volume rendering three-dimensional CT chest image showing the rib fusion at the right side, T1-2 and T8-9 levels (arrows).. F. Volume rendering three-dimensional CT lumbar image showing the sacral defect with the absence of the S5 foramina and the lumbalization (arrows) at the right side of S1.. G. T1 and T2 weighted sagittal images showing cervical fusion with enlargement of spinal canal and the dural sac ectasia (arrows).. H. Intravenous urography showing a triple renal pelvis (arrow) in the left kidney.
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The physical examination on admission revealed asymmetry in his chest and neck; there was also a sacral dimple and hypoplasia of the right thumb (Fig. 1A). These skeletal anomalies were confirmed by 3D-CT (Figs. 1B-D). We also observed partial body fusion of T1-T2 on the 3D sagittal image (Fig. 1E), and this finding was not revealed by plain radiography, CT or the MR images. Spina bifida of L5, lumbalization at the right side of S1 and a sacral curve defect were demonstrated with the 3D-CT scan, and the CT was performed because of the sacral dimple (Fig. 1F). The MRI examination depicted levels of cervical fusion enlargement of the spinal canal and dural sac ectasia (Fig. 1G). Intravenous urography (IVU) was performed because of his enuresis nocturna, and it identified a triple renal pelvis in the left kidney (Fig. 1H).