Ventrolateral lumbar disc herniation with psoas edema

Case contributed by Dr Nick Tarasov

Presentation

Left L3-L4 distribution radicular pain and weakness.

Patient Data

Age: 50 years
Gender: Female

There are no posterior or foraminal disc herniations.

Left ventrolateral (anterior) annulus fibrosus fissure and disc protrusion at the L3-L4 level causes adjacent iliopsoas muscle edema / inflammation.

The left ventrolateral (anterior) annulus fibrosus fissure and disc protrusion at the L3-L4 level.

 

Case Discussion

This case shows a common cause of sciatic radiculopathy but an uncommon site and pain mechanism. The absence of posterior and lateral disc hernitation is also unusual at age of 50 years.

Please note the value of the coronal STIR sequence, highly sensitive to paravertebral muscle edema.

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