Vertebral and epidural metastases

Case contributed by A.Prof Frank Gaillard

Presentation

New right arm weakness.

Patient Data

Age: 60 years
Gender: Male
Modality: MRI

Heterogenous marrow signal with patchy enhancement affecting the entire spine consistent with extensive diffuse metastasis. Multiple masses are seen within the extradural space at the T1/2 level predominantly within the posterior and right aspects. The largest mass measures 20 x 16 mm. The masses are low on T1, heterogenous on T2 and demonstrate contrast enhancement. The mass effect results in leftward displacement of the spinal cord with cord compression and localised cord signal abnormality. T3 vertebral body fracture is similar to previous, however convex low T2 enhancing material is seen extending into the anterior spinal canal resulting in effacement of the anterior thecal sac.

Concavity to the superior endplate of L2 and L3 with minor retropulsion of the L3 bone fragments is unchanged in appearance. Dural enhancement seen within the thoracic spine. Diffuse disc bulges at the C5/6 and C6/7 levels resulting in mild spinal canal stenosis and moderate stenosis of the right C5/6 neural exit foramen.

Diffuse disc bulge at the L2/3 level and L3/4 level without significant spinal canal or neural exit foraminal stenosis. Stable appearances of right L4/5 paracentral disc protrusion extending into the neural exit foramen with compression of the exiting L4 nerve root and right L5/S1 paracentral disc protrusion resulting in contact of the exiting right L5 nerve root.

Conclusion:

Diffuse osseous metastases throughout the entire cervical, thoracic and lumbar spine. Extradural metastatic masses at the T1/2 level resulting in cord compression and localised cord signal abnormality.

Modality: X-ray

Diffuse patchy sclerotic bone change seen throughout the imaged skeleton, consistent with the known history of prostatic metastases. 

Modality: CT

Diffuse patchy sclerotic bone change seen throughout the imaged skeleton, consistent with the known history of prostatic metastases. 

Case Discussion

Widespread sclerotic bony metastases are characteristic of prostate cancer, in this case with epidural extension and cord compression. This patient had a known history of established skeletal prostatic metastases. 

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Case Information

rID: 35608
Case created: 13th Apr 2015
Last edited: 24th Apr 2017
Inclusion in quiz mode: Included

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