The Journal of Bone and Joint Surgery

Image Quiz
*Neck Pain in a Forty-Six-Year-Old Woman (continued)¹*
The computed tomographic scan (Fig. 1) shows invasion of the lesion into the right lateral masses of both the first and second cervical vertebrae. The estimated size of the lesion was 2.5 by 1.5 by 1.0 cm. The lesion also extended into the foramen transversarium of the second cervical vertebra with lateral displacement of the vertebral artery (Fig. 1); however, the spinal cord was not involved. An associated soft-tissue mass was noted adjacent to the eroded cortex of the second cervical vertebra. On magnetic resonance imaging, the mass was isointense compared with skeletal muscle on T1-weighted images and mildly hyperintense on T2-weighted images (Fig. 2) but less intense than cerebrospinal fluid.
Fig. 1	Fig. 1 Computed tomographic image shows a lytic lesion involving the right aspect of the odontoid process, the right lateral mass of the second cervical vertebra, and the foramen transversarium. Note the lateral cortical destruction and associated soft-tissue mass displacing the vertebral artery (arrow) laterally. For larger view, click on image
Fig. 2	Fig. 2 Transverse T2-weighted magnetic resonance image shows the soft-tissue mass (M) to be mildly hyperintense compared with skeletal muscle. For larger view, click on image
A biopsy was performed.