Extruded thoracic disc

Case contributed by A.Prof Frank Gaillard

Presentation

Back pain.

Patient Data

Age: 45 years
MRI

At T9/T10, on the left side of the cord, displacing the cord slightly towards the right, without appreciable cord signal abnormality is a lesion is of markedly low signal on T2, low signal on T1 (lower than the adjacent cord), and enhancement at its periphery, which is somewhat ill-defined.

On axial imaging the lesion can be seen occupying the left T9/T10 neural exit foramen. It is difficult to determine whether this lesion is intra or extra-thecal in location although based on axial imaging I favour the latter.

Best appreciated on sagittal T2-weighted imaging the central non-enhancing hypointense component is in close proximity to, and possibly continuous with the T9/T10 disc.

Conclusion: Left sided T9/T10 lesion has appearances that favour an extruded disc with surrounding reactive inflammatory enhancement, despite the relatively normal adjacent disc. The main differential is that of a meningioma with central calcification. This should be readily apparent on CT.

CT

AT T9/10, there is mild disc space narrowing with prominent intradiscal calcification. There is an extradural lesion at T9-T10 impinging upon the left side of the thoracic cord. This demonstrates subtle areas of mineralisation within it, corresponding to the low signal T1-T2 lesion on MRI. The lesion extends into the left T9-T10 intervertebral foramen. The lesion appears contiguous with the T9-T10 disc. The appearances are favoured to represent a partially mineralised T9-T10 disc extrusion. 

Case Discussion

The patient went on to have a laminectomy and resection of the lesion which confirmed the absence of tumour and supported the diagnosis of an extruded disc.

Histology:

MICROSCOPIC DESCRIPTION: Sections show diathermied fibroadipose tissue with foci of dystrophic calcification, haemosiderin laden macrophages and degenerative changes. No tumour is seen.

DIAGNOSIS: Fibroadipose tissue with degenerative changes.

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Case information

rID: 48751
Case created: 22nd Oct 2016
Last edited: 8th Nov 2016
Inclusion in quiz mode: Included

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