Musculoskeletal case 15. Presentation
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* William C. Torreggiani
* Khalid Al-Ismail
* Peter L. Munk
* Mark J. Lee

A 44-year-old woman was referred to the Emergency Department for evaluation of chest and abdominal pain. The chest pain had developed about 1 week earlier and had gradually become worse and spread into the abdomen. She had a long history of medical problems, including a deforming scoliosis of her thoracic and lumbar spine, for which she had undergone several surgical procedures over the past 2 decades. On examination, there was still a marked scoliosis of the spine as well as deformity of the chest wall. The patient was tall and slender despite her spinal abnormalities.

Plain radiographs (not shown) demonstrated marked scoliosis of the thoracic and lumbar spine with associated surgical spinal fusion devices. Contrast-enhanced computed tomography of the thorax and abdomen was arranged for further evaluation. Fig. 1 is an axial computed tomographic image at the level of the aortic arch. There is evidence of a linear band extending through the transverse aortic arch and proximal descending aorta (Fig. 1, arrow). In addition there is differential enhancement of the aortic lumen. Metallic artifact from Harrington’s rods is present within the spine. Fig. 2, an image at a lower level within the thorax, also shows a linear band traversing the descending aorta (arrow). Marked deformity of the thoracic cage is present. The spinal canal is enlarged. An axial image through the upper abdomen (Fig. 3) again shows a linear band within the abdominal aorta. The spinal canal is once more noted to be large. Linear bands are also demonstrated within both common iliac vessels in an axial image at the level of the common iliac bifurcation (Fig. 4, arrows). There is marked widening of the spinal canal at this level, in keeping with dural ectasia.

![FIG. 1](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/44/2/92/F1.medium.gif)

[FIG. 1](http://canjsurg.ca/content/44/2/92/F1)

FIG. 1 

![FIG. 2](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/44/2/92/F2.medium.gif)

[FIG. 2](http://canjsurg.ca/content/44/2/92/F2)

FIG. 2 

![FIG. 3](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/44/2/92/F3.medium.gif)

[FIG. 3](http://canjsurg.ca/content/44/2/92/F3)

FIG. 3 

![FIG. 4](http://canjsurg.ca/https://www.canjsurg.ca/content/cjs/44/2/92/F4.medium.gif)

[FIG. 4](http://canjsurg.ca/content/44/2/92/F4)

FIG. 4 

What is the most likely diagnosis?

For the answer and discussion see page 101.

## Footnotes

*   Section Editor: Peter L. Munk, MD

*   Inquiries about this section should be directed to Dr. Peter L. Munk, Professor, Department of Radiology, Vancouver General Hospital and Health Sciences Centre, 855 West 12th Ave., Vancouver BC V5Z 1M9.