Presentation
Low back pain and right sciatica.
Patient Data
Two left paravertebral ovoid masses, the smaller one seen at left para-aortic region opposite L2/L3 intervertebral disc and the larger one just lateral to the left common iliac artery opposite L5 vertebra, with a third similar ovoid mass at a lower level laterally anterior to the left iliopsoas muscle, representing enlarged pathological lymph nodes.
Altered bone marrow signals are seen at the right iliac bone, showing low signals on T1 WIs and heterogeneous bright signals on T2 WIs and neurography, with bone expansion and cortical breach, exhibiting heterogeneous avid post-contrast enhancement, highly suggestive of aggressive marrow infiltrative lesion.
Another small focus of low signals on T1 & T2 WIs is noted at S1 vertebra.
Degenerative lumbar disc disease.
Follow up metastatic work-up after 1 year included a CT study of which these bone window images show multiple sclerotic deposits.
Case Discussion
The patient initially presented with low back pain radiating to the right thigh, for which an MRI study for the lumbosacral spine was requested. This revealed marrow infiltrative lesions and pathological para-aortic lymphadenopathy, raising the possibility of metastasis; considering the site and nature of the lesions, metastatic prostatic carcinoma was suggested. Laboratory investigations including PSA, and a further MRI study for the prostate, followed by biopsy and histopathology, confirmed the diagnosis of metastatic cancer prostate. Follow up CT after 1 year of chemotherapy shows further dissemination and progression of the sclerotic metastatic deposits.
This case confirms the importance of reviewing the surrounding tissue whenever reporting spine MRI studies.
Unable to process the form. Check for errors and try again.