Intramedullary metastasis from lung cancer

Case contributed by Dr Ian Bickle


Lifelong smoker. Reluctant hospital attender. Odd sensation in legs. T4 sensory level on examination.

Patient Data

Age: 70
Gender: Female

MRI WHOLE SPINE - with contrast

1.5cm expansile enhancing lesion intramedullary lesion at the level of T2/T3.

The whole cord from the craniocervical to the conus is diffusely high signal in keeping with cord edema.

Multi-level cervical disc-osteophyte complexes with remodeling of the dorsal aspect of the cord.

No bone metastases.

Incidental sacral Tarlov cysts.

Overfilled urinary bladder in keeping with retention.

4cm left lower lobe mass straddling the basal segments extending to the hilum.

1cm nodule in the lateral basal segment of the left lower lobe.

1.8cm left upper lobe mass.

Case Discussion

Solitary thoracic intramedullary metastasis from a lung primary.  Lung cancer is the commonest malignancy to give rise to intramedullary mestatases.

Fine needle aspiration cytology of the lung mass was acquired under CT guidance.

Histological diagnosis:  Adenocarcinoma of the lung

This case provides a good basis on which to examine a fellowship candidate for describing the findings on the MRI, giving a differential and suggesting further investigations.

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