Presentation
Eye enucleation due to melanoma couple of years prior. Known metastatic disease in multiple organs, spine involvement suspected.
Patient Data
Lumbosacral transitional vertebrae - probable sacralization of L5 based on the shown ribs and iliolumbar ligament.
The lateral aspect of the Th12 vertebral body shows pathological SI with lobulated mass centered in the region of the right Th12/L1 foramen, with paraspinal and intraspinal propagation, compressing the thecal sac with no obvious compression of the medulla/conus medullaris.
Other findings include dextroscoliosis, narrowing of the intervertebral space Th12/L1, less L4/L5 with erosions and MODIC type II endplate changes, osteophytes and disc protrusions, and known other metastases.
Case Discussion
Considering history of ocular melanoma and known pulmonary, hepatic, pancreatic, soft tissue metastases, as well as slightly higher SI on non-contrast T1 sequence, the primary differential diagnosis is metastatic melanoma.
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