Hodgkins lymphoma - spine

Case contributed by Dr Ian Bickle

Presentation

Upper back pain for several months. No trauma. Now more acute. Raised ESR and WCC.

Patient Data

Age: 33
Gender: Male
Modality: X-ray

Partial collapse of the T4 and T5 vertebral bodies with an associated a bilateral symmetrical paraspinal mass.

Modality: MRI

Altered signal in T3, T4 and T5 with diffuse vertebral body enhancement.  Discs spared.

Severe collapse with at least 50% loss of vertebral body height of T4 and T5 with a resultant gibbus.

Associated with the above is a symmetrical rind of contiguous enhancing pre-and paravertebral soft tissue as well as enhancing soft tissue extending into the epidural space with resultant severe narrowing of the central canal and partial compression of the cord.

No signal change in the cord to imply oedema.

The remainder of the spine is normal.

Soft tissue name anterior mediastinum measuring up to 5 cm.

Small bilateral pleural effusions.

Cervical lymphadenopathy more pronounced on the left, the largest being a 2.5 cm left supraclavicular lymph node.

Enhancing 1.5cm pleural based nodule in the posterior aspect of the left upper thoracic cavity.
 

 

Modality: Ultrasound

Irregular 3.3cm soft tissue mass in the left supraclavicular fossa (correlating with the localiser of the MRI).

Ultrasound guided core biopsy was undertaken.

Modality: CT

CT chest

3.2 cm left supraclavicular lymph node.

Diffuse large volume mediastinal lymphadenopathy at multiple nodal stations. The largest discrete node in the right paratracheal space measures 4.6 cm.

Partial collapse of T4 and T5 vertebral bodies as well as lucency of the T3 vertebral body with an associated kyphosis. Symmetrical rind of soft tissue at T4/T5 measuring up to 1.8 cm in depth.

Pericardial effusion measuring up to 1.7 cm.

Mottled sclerotic appearance of the mid sternum.

Tiny bilateral pleural effusions and bibasal atelectasis.

CT abdomen

1.7 cm enhancing lesion in segment 7 of the liver. The remainder of the solid organs are normal.

Several upper left periaortic lymph nodes measure up to 1.5 cm.
 

Modality: Photo

Supraclavicular lymph node biopsy report.

Case Discussion

This case illustrates Hodgkin's lymphoma presenting with spinal disease in an initially indolent fashion.  

TB spine was in the initial differential, especially in view of this being common in our institution and the patients laboratory results.

The case has multimodality imaging and the tissue diagnosis was acquired from image guided biopsy.

Learning point:   As the radiologist try to advise and if possible perform the safest and most pragmatic procedure to get a histological diagnosis for the patient.

This case could be used in a fellowship exam scenario.

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Case Information

rID: 47856
Case created: 6th Sep 2016
Last edited: 19th Sep 2016
Systems: Spine, Haematology
Inclusion in quiz mode: Included

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