Presentation
Low back pain.
Patient Data
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![](https://prod-images-static.radiopaedia.org/images/55659207/IM0208_thumb.jpeg)
![This study is a stack](/packs/stack-YQKLCKBI.gif)
![](https://prod-images-static.radiopaedia.org/images/55659115/IM0024_thumb.jpeg)
![This study is a stack](/packs/stack-YQKLCKBI.gif)
![](https://prod-images-static.radiopaedia.org/images/55658939/IM0024_thumb.jpeg)
![This study is a stack](/packs/stack-YQKLCKBI.gif)
![](https://prod-images-static.radiopaedia.org/images/55659012/IM0024_thumb.jpeg)
![This study is a stack](/packs/stack-YQKLCKBI.gif)
![](https://prod-images-static.radiopaedia.org/images/55658997/IM0024_thumb.jpeg)
![This study is a stack](/packs/stack-YQKLCKBI.gif)
![](https://prod-images-static.radiopaedia.org/images/55659071/IM0024_big_gallery.jpeg)
There is a well-defined intraosseous lesion of the L4 vertebral body of fatty density (mean density -62 HU) with sclerotic margin and small cortical interruption of the end-plate well-visualized on sagittal and coronal reformatted images. A small Schmorl node of the superior endplate of L3 is also noted.
The height of the vertebral bodies and disc spaces is preserved. No disc herniation is seen.
![](https://prod-images-static.radiopaedia.org/images/55659277/Sans_titre_big_gallery.jpeg)
Annotated image showing the mean density of the intravertebral lesion (-62 HU).
Case Discussion
CT features of a well-defined intraosseous lesion of fatty density with a sclerotic peripheral rim of the L4 vertebral body with cortical interruption of the superior endplate suggestive of a giant fatty Schmorl node.
The main differential diagnosis is an intraosseous lipoma (usually the cortex of the vertebral endplates is intact).