The patient initially presented with low back pain radiating to the right thigh, for which an MRI study for the lumbosacral spine was requested. This revealed marrow infiltrative lesions and pathological para-aortic lymphadenopathy, raising the possibility of metastasis; considering the site and nature of the lesions, metastatic prostatic carcinoma was suggested. Laboratory investigations including PSA, and a further MRI study for the prostate, followed by biopsy and histopathology, confirmed the diagnosis of metastatic cancer prostate. Follow up CT after 1 year of chemotherapy shows further dissemination and progression of the sclerotic metastatic deposits.

This case confirms the importance of reviewing the surrounding tissue whenever reporting spine MRI studies.