Acute Schmorl's node

Case contributed by Dr Henry Knipe

Presentation

Acute low back pain.

Patient Data

Age: 50 years
Gender: Male
CT

Lumbar scoliosis. Lucency within the L2 superior endplate with cortical erosion. No other focal lesion. Right nephrectomy. 

MRI

 At the right aspect of the L2 vertebral body just inferior to the endplate is a region of bone marrow edema centered on a disrupted and slightly depressed L2 superior endplates with edema extending into the right pedicle. Postcontrast enhancement is relatively diffuse in this region with normal signal intervertebral disc extending inferiorly in keeping with a Schmorl's node. Mild periosteal and paravertebral soft-tissue edema.

Mild L1/2 disc edema. No further focal osseous lesion is identified. Enhancement of the right L2 nerve root.

Previous right nephrectomy. Paraspinal soft tissues demonstrate no gross abnormality. 

Case Discussion

Bone marrow edema and enhancement centered inferior to the right aspect of the L2 superior endplate is favored to be an acute Schmorl's node with reactive edema. The main differential is a vertebral metastasis but the contiguity with the intervertebral disc and similar signal heavily favors an acute Schmorl's node despite a previous right nephrectomy for RCC. 

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Case information

rID: 83276
Published: 28th Jan 2021
Last edited: 28th Jan 2021
Inclusion in quiz mode: Included

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