QJM: An International Journal of Medicine, 2019, 1–2
doi: 10.1093/qjmed/hcz184
CLINICAL PICTURE
The corduroy appearance and the polka dot sign
A 64-year-old woman presented to our institution with a 7-month
history of gradually aggravated back pain. The patient denied expe-
riencing any other constitutional symptoms and no history of
trauma or surgery during the past years. No other relevant special
circumstances regarding her family history or personal history
were identified. Tenderness and percussion pain of thoracic
spine were shown, and other physical examination results were es-
sentially normal. Laboratory tests did not reveal any abnormities.
X-ray and computed tomographic scan of thoracic spine showed
significant ‘corduroy appearance’ on sagittal plane, and typical
‘polka dot sign’ on axial plane (Figure 1A and B). Magnetic reson-
ance imaging demonstrated abnormal signal intensity of the T4
vertebral body. Based on the criteria, diagnosis of the vertebral
hemangioma was considered. Tissue biopsy and percutaneous ver-
tebroplasty of T4 were performed and the postoperative pathology
was consistent with spinal vertebral hemangioma. At the 2-year
follow-up visit, she reported significant pain relief and no new
symptoms.
Figure 1. (A,B) Computed tomographic scan of thoracic spine showing significant ‘corduroy appearance’ on sagittal plane, and typical ‘polka dot sign’ on axial plane.
C The Author(s) 2019. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.
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Clinical picture
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This typical finding on radiography and computed tomog-
raphy is known as ‘corduroy appearance’ or ‘polka dot sign’,
which is caused by reduced bone density between much denser
vertical trabeculae in a non-expanded vertebral body.1
However, patient with the typical ‘corduroy appearance’ and
‘polka dot sign’ is extremely rare clinically. When radiographs
and computed tomography were taken to investigate spinal dis-
orders show the ‘corduroy appearance’ and ‘polka dot sign’, fur-
ther evaluations should be performed to look for the underlying
cause, particularly of the vertebral hemangioma.2 High suspi-
cion, characteristic corduroy appearance on the X-ray and polka
dot sign on the computed tomographic scan can usually enable
making the diagnosis.3 The present case highlights the import-
ance of accurate diagnosis and proper treatment for patients
with ‘corduroy appearance’ and ‘polka dot sign’.
Conflict of Interest: None declared.
1
 2 | QJM: An International Journal of Medicine, 2019, Vol. 0, No. 0

Photographs and text from: S.-Z. Liu and X. Zhou, Department References
of Orthopaedic Surgery, Peking Union Medical College Hospital,
1. Alfawareh M, Alotaibi T, Labeeb A, Audat Z. A symptomatic
Chinese Academy of Medical Sciences & Peking Union Medical
case of thoracic vertebral hemangioma causing lower limb
College, 1 Shuaifu Yuan, Beijing 100730, China; A. Song,
spastic paresis. Am J Case Rep 2016; 17:805–9.
Department of Endocrinology, Peking Union Medical College
2. Wang B, Zhang L, Yang S, Han S, Jiang L, Wei F, et al. Atypical
Hospital, Peking Union Medical College and Chinese Academy
radiographic features of aggressive vertebral hemangiomas.
of Medical Sciences, 1 Shuaifu Yuan, Beijing 100730, China; Y.-P.
J Bone Joint Surg Am 2019; 101:979–86.
Wang and Y. Liu, Department of Orthopaedic Surgery, Peking

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3. Gaudino S, Martucci M, Colantonio R, Lozupone E, Visconti E,
Union Medical College Hospital, Chinese Academy of Medical
Leone A, et al. A systematic approach to vertebral hemangi-
Sciences & Peking Union Medical College, 1 Shuaifu Yuan,
oma. Skeletal Radiol 2015; 44:25–36.
Beijing 100730, China. email: liuyong_pumch@163.com