Presentation
Low back pain.
Patient Data
Well-defined lucent lesions of the fatty density at L4 and L5 vertebral bodies with a peripheral sclerotic rim extending to the superior and inferior endplates at L4 and superior endplate at L5
Small Schmorl nodes of the superior endplate L3 are also noted.
Circumferential disc bulge at L3-L4.
Central disc herniation at L4-L5.
Case Discussion
CT features of a well-defined intraosseous lesion of the fatty density of the L4 and L5 vertebral bodies with a peripheral sclerotic rim and cortical interruption of the vertebral endplates suggestive of fatty Schmorl nodes (incidental findings).
On imaging, the main differential diagnosis is:
- an intraosseous lipoma: usually with an intact cortex of the vertebral endplates
-
atypical hemangioma:
- usually have a lower fat content
- "polka-dotted" or "salt and pepper" appearance on axial CT due to the thickened vertebral trabeculae