Presentation
Incidental finding on CT urography.
Patient Data
Age: 40 years
Gender: Male
From the case:
Giant fatty Schmorl node
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Well-defined lobulated lesion of the fatty density of L4 vertebral body with a peripheral sclerotic rim extending to the superior endplate which shows a small cortical interruption.
Small Schmorl nodes of the superior endplates from T11 to L3 are also noted.
osteophyte formation at L4.
From the case:
Giant fatty Schmorl node
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Annotated images showing:
- the mean density of the intravertebral lesion (-74 HU)
- cortical interruption of the superior endplate of L4 (yellow arrow)
Case Discussion
CT features of a well-defined lobulated lesion of fatty density of the L4 vertebral body with a sclerotic peripheral rim and cortical interruption of the superior endplate suggestive of a giant fatty Schmorl node.
On imaging, the main differential diagnosis is:
- an intraosseous lipoma: usually with the intact cortex of the vertebral endplates
-
atypical hemangioma:
- usually have a lower fat content
- "polka-dotted" or "salt and pepper" appearance on axial CT due to the thickened vertebral trabeculae
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