Presentation
Chronic headaches with a low back pain radiating to the left lower limb. Brain and lumbar MRI were performed the same day. The brain MRI was normal.
Patient Data
There is a well-defined ovoid soft tissue mass ( 18 x 16 x 12 mm) centered on the left L4 nerve root enlarging L4-L5 foramina with mild veretebral scalloping. It elicitis an iso-to slight high signal on T2/STIR with relatively homogeneous enhancement on postcontrast sequences.
Case Discussion
MRI features of L4 nerve sheath tumor probably schwannoma.
On imaging, schwannomas and neurofibromas can look identical, however, schwannomas are frequently associated with hemorrhage, intrinsic vascular changes (thrombosis, sinusoidal dilatation), cyst formation and fatty degeneration. These findings are rare in neurofibromas. For more details of their MRI features refer to the article on spinal nerve sheath tumors.
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