Imaging: Paraparetic Puggle

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3 replies
  1. Angelillo
    Angelillo says:

    I am most a CT person, but it seems for me, that in T13 there is an increased signal in vertebral body in t1 and t2+C. It should indicate inflamation/tumour of some short. theres is extradural compression of the spinal cord coming from left intervertebral foramen. Cannot go any fuirther, I would think of bony tumour but I can rule out nerve sheath tumor entering the vertebral canal and affecting the bone.
    regards
    Angel

  2. Andre
    Andre says:

    My guess: a nerve sheath tumor passing through the left T13-L1 intervertebral foramen, compressing the spinal cord.

  3. neuropetvet
    neuropetvet says:

    Thanks for playing along, Angelillo & Andre, and great thoughts! There is a right-sided to sometimes ventral extraparenchymal mass from T12/13 to T13/L1 causing moderate spinal cord compression. The mass is hyperintense on T2-weighted images, isointense on pre-contrast T1-weighted images, and displays marked, relatively homogenous contrast enhancement. There is also enhancement in the soft tissues around the T13 vertebral body and pedicle bilaterally, the right epaxial muscles (mild) and left extending dorsally from the foramen. The T13 vertebral body is hyperintense on T2-weighted and pre-contrast T1-weighted images, which could be due to fatty infiltration of the medullary bone, but it was still hyperintense on STIR images (not shown) ruling out fat and the vertebral body of T13 is mildly enhancing. Finally, there is enhancement of the meninges extending caudally on the sagittal post-contrast T1-weighted images to about L3/4. Based on all of these, my primary rule outs were neoplasia (lymphoma or other round cell/myeloid tumors > metastatic, carcinoma, etc.) vs. infectious/inflammatory disease (e.g., fungal, protozoal). Nerve sheath tumor and meningioma can cause some of these MRI features, but the contralateral enhancement, vertebral body enhancement, and extension along the meninges that far away from the primary mass would be very unusual.

    A right T12 to L1 hemilaminectomy was performed to debulk the mass and get a diagnosis. Histopathology = lymphoma. Patient doing very well with chemotherapy thus far.

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