Presentation
Lumbar pain for about six months. Referred from the general practitioner for an MRI.
Patient Data
There are multiple nodular foci of abnormal signal involving either the vertebral bodies and their posterior arches, characterized by a low signal on T1, a high signal on T2 Fat Sat and contrast enhancement. There is also some mild disc degeneration with disc bulging in L2/3, L3/4 and L4/5.
Case Discussion
This patient was referred for an MRI even without a previous lumbar spine radiograph, and the present study demonstrates what most likely represents bone metastatic disease to the spine.
When appearing as multiple and with an aleatory distribution, such as in this case, the diagnosis is easily made, as there are no differentials. However, sometimes a metastasis can appear as a single lesion involving one vertebral body, and special attention must be given to the MRI signal to not confuse it with a vertebral hemangioma, for example.
Further investigation looking for the primary tumor was advised for this case.
The most common primary neoplasms to be considered in this male patient are:
- lung cancer
- prostate cancer
- renal cell carcinoma
- gastrointestinal tract malignancies
- melanoma
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