Presentation
Lower back pain
Patient Data
Multiple scattered vertebral lesions with the following :
- L5 massively infiltrated showing:
- convex posterior cortex of the vertebral body
- involvement of both pedicles which are seen expanded
- it is seen abutting the ventral thecal aspect and encroaching upon both lateral recess with resultant canal stenosis
- showing T1 and T2 hypointense signal with mild enhancement
- some of the lesions show marginal enhancement
- no loss of signal in in-phase and out-of-phase sequences
- multiple lesions noted involving the sacrum and the iliac crest bilaterally with the similar pattern of the vertebral lesions
Case Discussion
The patient has history of metastatic breast cancer to the lung, so the vertebral lesions are mostly consistent with diffuse vertebral metastases. The lesions are most seen at post-contrast T1 fat sat sequence. T1 in-phase and out-of-phase sequences also help to confirm infiltrative vertebral lesion, seen as the absence of loss of signal in out-of-phase sequence at the sites of the vertebral lesions.
Decreased central height of L5 with bulging of anterior and posterior vertebral body borders are suggestive of malignant vertebral structural collapse (pathological compression fracture).
The present supporting features of malignant collapse of L5 include involvement of dorsal elements, bulging of the dorsal vertebral wall, involvement of the posterior half of the vertebral body, contrast enhancement and multisegmental involvement of vertebrae.