Carotid Plaque on X-Ray

The following radiographs on a recent patient shows many important things, the MOST important from a diagnositic standpoint is the carotic plaquing. This patient’s cervical spine is not being treated unitl I get the results of his Carotic Ultrasound from his Primary Care Physician.  This was an EASY call to make to the PCP and shows that our office is properly screening and managing patients.  I use these types of situations to reach out to the PCP as often as I can, believe me they appreciate it.  The plaquing shows up as “billowy” opacities at the anterior portion of the cervical above the shadow of the laynx.  DONT MISS THESE THINGS.  The rest of the findings on this case are below the pictures.   This patient cannot have an MRI due to his pacemaker.  CT is ordered.  

NEUTRAL VIEW

FLEXION VIEW 

EXTENSION VIEW 

IMPRESSIONS 

PROMINENT STRAIGHTENING/SLIGHT REVERSAL OF NORMAL CERVICAL LORDOSIS WHICH MIGHT BE SECONDARY TO MUSCLE SPASM. 

END PLATE SPURRING ANTERIOR BRIDGING OSTEOPHYTES AT ALMOST ALL INTERVERTEBRAL DISC LEVELS OF CERVICAL SPINE MOST PROMINENT AT THE LEVELS OFC4-C5 AND C5-C6 ASSOCIATED WITH ADVANCED LEVEL DISC SPACE NARROWING AND TO A LESSER EXTENT AT THE LEVELS OF C3-C4 AND C6-C7. 

SLIGHT ANTEROLISTHESIS OF C3 OVER C4 ON THE FLEXION VIEW NOTED. 

MINIMAL FIXED RETROLISTHESIS OF C4 OVER C5 SEEN ON NEUTRAL LATERAL AND BOTH FLEXION AND EXTENSION VIEWS. 

MILD FACET JOINT ARTHROPATHY INVOLVING MID AND LOWER CERVICAL SPINE LEVELS. 

FOCAL INCREASED CALCIFIC DENSITIES PROJECTING OVER THE SOFT TISSUES OF THE NECK BILATERALLY. IF CLINICALLY WARRANTED FURTHER EVALUATION WITH FOLLOW UP ULTRASOUND STUDY OF THE CAROTID VASCULATURE COULD BE OBTAINED FOR FURTHER ASSESSMENT AS THEY MAY REPRESENT ATHEROSCLEROTIC VASCULAR CALCIFICATIONS INVOLVING CAROTID VASCULATURE.