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Case Challenge: Spine MRI Cases

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Spine MRI Case Challenge Pre-Course Activities
2 topics

22b - Answer: A 30-year-old man with left paraspinal mass

David Yousem MBA, MD
David M Yousem, MBA, MD
Professor of Radiology, Vice Chairman and Associate Dean
Includes DICOM files

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Case Report

HISTORY: 30-year-old man with left paraspinal tumor resection on 11/16/2017.

Date of exam: Cervical spine examination from 11/2/2017 and thoracic and lumbar examinations from 10/30/2017.
Date reviewed at Johns Hopkins: 12/14/2017
Performed at: TCDI
Technique: MRI of the cervical, thoracic and lumbar spine with and without contrast.
Comparison: None.

FINDINGS:

THE IMAGES WERE SCANNED FROM THE ORIGINAL MR FILMS.  THERE IS  SIGNIFICANT SENSITIVITY LOSS BECAUSE OF THE PROCESS.  THE INTERPRETATION MAY ALSO BE LIMITED DUE TO THE RESOLUTION OF THE FILMS.

MRI OF THE LUMBAR SPINE WITH IV contrast.

This report assumes 5 non rib-bearing lumbar type vertebral bodies. The lowest of these is labeled as L5 in this report, and it is identified by the iliolumbar ligament.

Abdomen/Retroperitoneum:  

- Dumbbell-shaped circumscribed soft tissue mass extending from the left L2-3 neural foramen to the deep surface of the psoas muscle, isointense on T1 and heterogeneous mildly hyperintense on T2-weighted sequences. Centrally, the lesion has areas of cystic change or necrosis. On postcontrast images, there is faint enhancement of the noncystic components.

- Well-circumscribed soft tissue mass extending from the left L3-4 neuroforamen with retroperitoneal extension, deep to the left psoas muscle which is isointense on T1-weighted and heterogeneous on T2-weighted images. Centrally the lesion has cystic/necrotic components with fluid/fluid level. Enhancement of the noncystic components of the lesion.

Paraspinous muscles and soft tissues:  Severe atrophy of the left psoas muscle with subtle edema distally.

Bones:  The vertebral body heights are preserved. Small atypical hemangioma versus Modic type I degenerative change at the superior endplate of L2. 0.8 mm hemangioma in the center of L2 vertebral body.

Alignment:  No spondylolisthesis. There is straightening of the lumbar curvature.
Sacroiliac joints:  Intact.

Developmental stenosis:  Absent.
Nerves:  The conus medullaris is normal in location, terminating at L1.

T12-L1:  No significant spinal canal or neural foraminal narrowing.

L1-2:  No significant spinal canal or neural foraminal narrowing.

L2-3:  No significant spinal canal or right neural foraminal narrowing.
Left neural foraminal mass, as described.

L3-4:  Small disc protrusion. No significant spinal canal or right neural
foraminal narrowing. Left neural foraminal mass, as described.

L4-5:  Small disc protrusion. No significant spinal canal or neural
foraminal narrowing.

L5-S1:  Disc desiccation, broad-based disc bulge and annular fissuring.
Mild spinal canal stenosis. No neural foraminal narrowing.

IMPRESSION:

MRI OF THE LUMBAR SPINE WITH CONTRAST:
Two separate heterogeneous centrally cystic/necrotic masses extending from the left L2-3 and L3-4 neuroforamina to the ipsilateral retroperitoneum deep to the severely atrophic psoas muscle. Findings likely represent schwannomas.

LESSON 6, TOPIC 6

Case Challenge: Spine MRI Cases

Case Challenge

last updated: 2022-03-08 19:55:52

created: 2022-03-08 19:55:52

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