Presentation
Patient known with NF 1 presented with scoliosis but no neurological fallout.
Patient Data
The frontal radiograph shows marked mid -thoracic levo-scoliosis with a well circumscribed posterior mediastinal mass. The mass does not obscure the right heart border or the hemi-diaphragam. There is loss of intervertebral disc spaces between the mid-thoracic vertebrae. The lateral radiograph shows a posterior mediastinal well circumscribed opacity which has caused scalloping of the posterior vertebral margin and marked kyphosis of the thoracic spine.
MRI confirms posterior vertebral scalloping with enlargement of the dural sac and root sheath from T8 - T10 with an anterior ballooning of the sac at T9 on the right in keeping with dural ectasia with a right anterior meningocoele. At the level of T8 the spinal cord is displaced to the right. The neural foramens are enlarged. Incidental finding of pilocytic astrocytoma in the cerebellum with multiple focal areas of signal intensity (FASI) in keeping with NF 1.
Case Discussion
Dural ectsia is defined as widening of the dural sac and is associated with NF 1. In this case there is a large anterior out pouching of this dural entasis which has resulted in scoliosis which was the patients presenting complaint. As there is no spinal stenosis patients rarely have neurological fallout as nerves are floating freely in the enlarged CSF space.
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