Interactive Transcript
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This was a case of a patient who was being evaluated
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for a thoracic aortic aneurysm study,
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and this was a CTA that was being done.
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However,
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the body CT people identified that there was an
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abnormality in the thoracic spinal column.
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And we see that within the intradural
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extramedullary space,
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we have a mass which is rounded and appears to
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be eccentric or outside the spinal cord.
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So, again, intradural but extramedullary.
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How do we know that this is not arising
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from the bone? On the sagittal scan,
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it actually looks like it could be
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a lesion of the spinous process,
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in which case it would probably be called an extradural
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lesion. For this reason, an MRI was requested.
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Here is the MRI scan that was performed after
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the CTA identified the abnormality. And when
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we look at the MRI scan on the T1-weighted
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and T2-weighted scan,
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I think we're more comfortable in saying that this
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is indeed an intradural extramedullary lesion.
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How so? On this example,
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you see that there is a meniscus sign.
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So the CSF space is widened at the level of the lesion
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above and below the lesion, and therefore,
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this must be intradural extramedullary.
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If it really was arising from the spinous process,
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as we were concerned about with the CT scan,
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it would lead to narrowing of the CSF
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space at the level of the lesion.
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So this is indeed a calcified intradural
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extramedullary lesion. And with that,
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we would say this is most likely a meningioma.
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We'd want to look at the post gadolinium-enhanced scans
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because meningiomas do show typically
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uniform enhancement. Now, this is a little bit tricky because
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this lesion was calcified,
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and calcification generally does not show enhancement.
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But let's let's look at it nonetheless.
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So let's pull down the post gadolinium-enhanced scans,
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and I will then magnify this for you and
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bring it up a little bit into our area.
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So there we go. So, on this pair of scans,
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we have the non-contrast scan on the right and the
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post-contrast T1-weighted scan on the left.
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And what you see is indeed an enhancing lesion that is
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in the intradural extramedullary compartment in the thoracic
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spine, which showed calcification. This is a meningioma.
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Absolutely.
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Move on to the next case.
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