Dorsal sequestrated disc fragment
Right sided sciatica.
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A peripherally enhancing lesion dorsal to the theca is located at the L2/3 level. Centrally it is of intermediate T1 and intermediate to high T2 signal similar to the nucleus of discs. Enhancement is peripheral and somewhat ill-defined. Diffusion is similar to disc nucleus. Importantly the L2/3 disc has lost a little height and has an annular fissure on the right. In contrast, the right facet joint adjacent to the lesion appears normal.
Features are consistent with a dorsal sequestrated disc fragment.
The patient went on to have a laminectomy and resection.
Section show fragments of nucleus pulposus and annulus. The nucleus appears unremarkable. Within the annulus, there are foci of reactive vascular proliferation and scattered chronic inflammatory cells including lymphocytes and macrophages, consistent with prolapse. No acute or granulomatous inflammation is seen. There is no evidence of tumour.
DIAGNOSIS: Disc material.
Dorsal epidural disc migration is uncommon and needs to be considered when faced with a dorsal epidural mass. Acutely peripheral enhancement will be present.