MRI of difficult discs

Upper lumbar spine far lateral disc herniations masquerading as peripheral nerve sheath tumors: illustrative cases

“…Interestingly, 1 recent radiological series describing MRI characteristics of different disc herniations showed a left L2–3 sequestered foraminal disc herniation that was also isointense on T1-weighted imaging and hyperintense on T2-weighted imaging that was suspicious for breast metastasis given the patient’s prior history of breast cancer. 11 Despite being rarer, this example highlights that upper lumbar spine disc herniations can be misdiagnosed as tumors but may be underreported in the literature.…”

“…Migratory disc herniations can travel to various locations, including epidural, intradural, intraneural, lateral (intraforaminal or extraforaminal), or retroperitoneal spaces. [5][6][7][8][9][10][11] Because these fragments can separate from the parent defect, they can present as isolated distinct lesions and appear differently than typical disc herniations on imaging. These variations in imaging characteristics can make diagnosing far lateral disc herniations challenging.…”

“…Despite its less frequent occurrence in the upper lumbar spine at the L1-2 and L2-3 levels, far lateral disc herniations can occur in these segments and imitate peripheral nerve sheath tumors radiographically. 5,6,8,11,16 Previous case reports and a literature review described lateral disc herniations in the lower lumbar spine and lumbosacral plexuses that mimicked a nerve sheath tumor (Table 1). [5][6][7][8]17 Cases 1 and 2 are the first known reported cases of an L1-2 and L2-3 far lateral disc herniation mimicking a peripheral nerve sheath tumor.…”

“…Migratory disc fragments are usually hypointense or isointense on T1-weighted MRI and hyperintense on T2-weighted MRI due to residual water content or water gain from inflammation. 11 , 12 Gadolinium contrast can help differentiate herniated disc material from tumors, postoperative scar tissue, or abscesses. Generally, disc material is avascular and thus does not enhance with intravenous contrast, while tumors usually extensively enhance with contrast.…”

Imminent rupture of infected aortic aneurysm presenting as lower back pain in an older patient

“…IAAA does not present with serious symptoms in the early stages, and back pain is the main complaint in 44% cases; therefore, orthopedicians are likely to be involved. However, in cases of lower back pain without the primary complaint of fever, abdominal examinations and blood investigations are rarely performed, and orthopedic surgeons tend to focus only on their area of expertise in diagnostic imaging 13,14 . Focusing on the spine and spinal cord, without paying attention to the soft tissues that appear in the imaging, can lead to overlooking serious diseases such as IAAA.…”