Acute lymphoid leukemia (ALL)

Case contributed by Dr Maxime St-Amant

Diagnosis certain

Presentation

Haemotologic abnormalities.

Patient Data

Age: 17

Gender: Male

From the case: Acute lymphoid leukemia (ALL)

MRI

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Sagittal T1

MRI shows diffusely hypointense T1 vertebrae with multiple vertebral fractures. At some level, there is a posterior extension of the fractures which compresses the thecal sac, without significant spinal stenosis / radicular compression.

It is also worth noting that there is hepatomegaly (> 15 cm cephalo-caudal) & splenomegaly (> 13 cm cephalocaudal). No lymphadenopathy were seen, however.

Case Discussion

ALL was confirmed in this patient after bone marrow biopsy. It is the most common leukemia in childhood. Characteristically, it presents with diffusely hypointense T1 vertebral bodies (leukemic infiltration replacing the normal fatty marrow), hyperintense T2 & hyperintense STIR sequences. Pathologic fractures are frequently seen and can mimmic non-accidental trauma.

With this type of signals, multiple fractures & hepatosplenomegaly, there are no significant differential diagnosis worth mentionning except for other types of leukemia.