case_images: PMC4604638_01
case_images: (a) Axial and (b) coronal cervical spine computed tomography (bony windows) demonstrating destructive bony changes centered in the left atlanto-occipital junction between the base of the left occipital condyle and the superior articular facet of the left lateral mass of C1
case_images: SNI-6-157-g001.jpg
case_images: PMC4604638_01_SNI-6-157-g001.jpg
case_images: F1
case_images: Cervical computerized tomography (CT) showed destructive bony changes at the left atlanto-occipital junction (between the left occipital condyle and superior articular facet of the left lateral mass of C1); there was a soft tissue mass between these plus left-sided lateral subluxation of C1-C2 [Figures 1 and 2].
case_images: (a) Axial and (b) Sagittal cervical spine computerized tomography with bony changes as described in Figure 1. The presence of an associated soft tissue mass between these bony changes and left-sided lateral subluxation of C1 with respect to C2 is also appreciated
case_images: SNI-6-157-g002.jpg
case_images: PMC4604638_01_SNI-6-157-g002.jpg
case_images: F2
case_images: Cervical computerized tomography (CT) showed destructive bony changes at the left atlanto-occipital junction (between the left occipital condyle and superior articular facet of the left lateral mass of C1); there was a soft tissue mass between these plus left-sided lateral subluxation of C1-C2 [Figures 1 and 2].
case_images: Coronal computerized tomography chest, abdomen, and pelvis (bony windows) revealing poorly-defined sclerotic lesions in the left half of the S1 vertebral body, right iliac body, left inferior pubic ramus, left ischial tuberosity, and in the left iliac body, abutting the sacroiliac joint
case_images: SNI-6-157-g003.jpg
case_images: PMC4604638_01_SNI-6-157-g003.jpg
case_images: F3
case_images: A CT of the chest, abdomen, and pelvis showed lytic and sclerotic bony lesions in the ribs, pelvis, sacrum, and right acromion [Figure 3].
case_images: (a) Flexion and (b) extension cervical spine X-rays at 6-month review demonstrate no spondylolisthesis or vertebral slippage with stable atlanto-dens interval
case_images: SNI-6-157-g004.jpg
case_images: PMC4604638_01_SNI-6-157-g004.jpg
case_images: F4
case_images: Spinal immobilization was maintained for 6 months after which cervical CT and flexion-extension X-rays confirmed C1/C2 stability [Figure 4].