Presentation
Patient complaining in pain in the left hip and left sciatica.
Patient Data
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MRI lumbar spine images showing a well-defined fusiform mass posterior to the left psoas muscle, on the left of the L5 vertebral body, and along the course of L4 nerve, at the exact point where it receives the L3 nerve ramus (transition of lumbar plexus and proximal femoral nerve). Although the fact that limited sequences were available, please note that this protocol was performed focusing on lumbar hernia, it is possible to infer that there is a big component of central cystic degeneration.
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Yellow arrow following the left L4 root until the mass.
Blue arrow following ramus of L3.
Red arrow showing what probably corresponds to the femoral nerve.
Case Discussion
This case demonstrates a cause of extra-spinal sciatica: a probable schwannoma involving the origin of the left femoral nerve. Unfortunately, this patient was referred to another institution and no follow-up image with a dedicated protocol or histology results were available. As discussed before, in the second question, the lesion has strong features to support the diagnosis of a schwannoma instead its differentials.
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