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Answer: Acute fractures are associated with edema, which is seen as high signal on inversion recovery (STIR) images. Chronic fractures do not show this feature.

The patient underwent vertebroplasty of the T5 vertebral body with subsequent relief of pain.

AP and lateral views of the thoracic spine post vertebroplasty show good distribution of cement in the T5 vertebral body.

Vertebral compression fractures are a known but underdiagnosed cause of chest pain. The presentation overlaps considerably with cardiac, pulmonary and thromboembolic causes of chest pain. In addition, subtle fractures may be missed on chest x-ray (particularly the portable AP x-rays often obtained in the ED) and there is often a low index of suspicion.

MRI is the preferred modality for the diagnosis of acute vertebral body compression fractures. CT and x-ray can demonstrate compression deformities, but cannot differentiate acute from healed fractures. MRI is able to differentiate between acute and chronic fractures through the ability to detect edema in the presence of an acute fracture.