Presentation
The patient reports progressive thoracic pain, loss of strength at the T4 sensory level, gradual deterioration of neurological status with lower limb paralysis, and loss of sphincter control.
Patient Data
CT scan of the thoracic spine reveals an osteolytic bony lesion involving T3 left posterior element and vertebral body, with a soft tissue mass resulting in cord compression.
Conclusion: T3 vertebral lytic lesion.
MR imaging shows an expansile mass involving the T3 left-sided posterior arch and vertebral body, destroying the lamina and pedicle with epidural extension. The mass compresses the cord, pushing it forward and to the right. The tumor has a heterogeneous appearance on both T1 and T2-weighted MR, with focal areas of high T1 signal, presumably representing blood. There are multiple internal septations with enhancement and fluid-fluid levels.
Conclusion: Findings are suggestive of an aneurysmal bone cyst.
Pathology:
The patient underwent surgical resection of the tumor. The histopathology showed a pattern compatible with an aneurysmal bone cyst.
Case Discussion
This case illustrates the radiological findings of an aneurysmal bone cyst with the typical MRI fluid-fluid levels and septations separating the cysts.
Aneurysmal bone cysts are benign giant cell-rich lesions of unknown cause and are sometimes difficult to distinguish from other bone tumors 1-6. The diagnosis of this lesion is possible by a combination of typical radiological and pathological features 1-6.
Case courtesy:
Isabela Oliveira, MD - PGY-3, radiology resident, Department of Radiology
Patrícia Menandro, MD – PGY-3, radiology resident, Department of Radiology
Antonio Rodrigues de Aguiar Neto, MD - radiologist, Department of Radiology
Hospital da Restauração – Recife, PE – Brazil