Wk 9, Case 3 - Review

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Report

Patient History
20 year-old male with a skin lesion of the back of the neck who presented to clinic with 3 weeks of progressively worsening weakness of his left lower extremity. The patient and his parents indicate that approximately 3 weeks ago he started requiring lifting his leg with his hands when he was moving from his wheelchair and standing has been significantly difficult. He had 3/5 strength in his left lower extremity on exam, a positive Babinsky sign and clonus at the left ankle.

Findings
There is a dumbbell-shaped intradural extramedullary and extradural lobulated mass extending from the left epidural space at the T9 level and extending through the left T9-T10 neural foramen into the dural space. The mass measures up to 5.9 x 4.1 x 3.5 cm (TV x AP x CC). The mass occupies the left half of the spinal canal compressing and displacing the spinal cord to the right with marked mass effect, unchanged from the prior examination. The extraforaminal portion extends into the pleural space and is contiguous with plexiform lesion along the intercostal nerves, unchanged. The plexiform portion shows essentially no enhancement on the postcontrast images.This lesion causes smooth scalloping along the posterior left aspect of the T9 vertebral body, unchanged. Numerous T2 hyperintense subcutaneous nodules again noted. T2 hyperintensity within a few additional intercostal nerves consistent with tiny sheath tumors.

Alignment, marrow signal, and vertebral height is normal throughout the thoracic spine. No evidence of fracture. No focal osseous lesion.No signal abnormality within the cervical spinal cord. No abnormal enhancement within the spinal cord.Spinal canal is patent at all remaining levels. Foramina are patent at all other levels.

Impressions
Left T9-T10 intradural extramedullary and extradural neurofibroma tumor centered within the left T9-T10 neural foramen causing marked mass effect on the spinal cord and extending into the left pleural space and is contiguous with a plexiform intercostal nerve lesion. Mass effect on the spinal cord.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Joshua P Nickerson, MD

Associate Professor of Neuroradiology

Oregon Health & Science University

Francis Deng, MD

Assistant Professor of Radiology and Radiological Science

Johns Hopkins University School of Medicine

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Wk 9, Case 3 - Review