Low thoracic and high lumbar back pain with history of neurofibromatosis type I. BRACHIAL PLEXUS: There is dextroconvex scoliosis of the mid cervical spine. The cervical vertebral bodies and a intervertebral disc spaces appear dysplastic. There is severe kyphosis of the cervical spine centered at C3-4 with lordosis centered at C6-7. A grade 1 retrolisthesis of C4 on C5 is seen.There is a 1.8 x 3.1 cm heterogeneously T2 hyperintense soft tissue lesion extending between the anterior arch of C1 and the dens causing expansion of the atlantodens interval up to 6 mm (series 501, image 47). This lesion is new or significantly increased since prior examination. The transverse ligament appears grossly intact but is stretched.There is a 1.6 x 1.4 cm T2 hyperintense lesion, likely a neurofibroma, expanding the left hypoglossal canal (series 701, image 74). In addition, there is a 1.4 x 2.0 cm expansile lesion involving the left C2-C3 neural foramen, also likely a neurofibroma. There appears to be a small amount of epidural fluid located along the posterior right margin of the thecal sac at the C3 level (series 701, image 51), similar to prior examination. There is moderate right neuroforaminal stenosis at C4-5 and C5-C6 secondary to right posterior disc osteophyte complex formation. The spinal cord demonstrates normal caliber and signal intensity.There are numerous ovoid T2 hyperintense lesions along the left jugular chain within the neck. The largest lesion measures 4.3 x 2.4 cm (coronal by transverse) (series 201, image 26). This lesion appears to impinge upon or perhaps arise from the exiting left upper cervical spine nerve roots. There are numerous small lesions along the distal left brachial plexus as well, however these lesions do not appear to significantly impinge upon the nerves. THORACIC SPINE: The thoracic alignment is preserved. The vertebral body heights and intervertebral disc spaces are maintained. There is no significant neuroforaminal or central spinal stenosis. The spinal cord demonstrates normal caliber and signal intensity.LUMBAR SPINE: The lumbar alignment is preserved. The vertebral body heights and intervertebral disc spaces are maintained. No worrisome focal marrow signal is identified. The spinal cord and conus demonstrate normal signal and morphology. The conus terminates at L2. A fatty filum is noted. No neuroforaminal stenosis or central stenosis is noted. Several T2 hyperintense lesions in the periaortic and retroperitoneal space are nonspecific and may be related to lymph nodes versus additional small neurofibromas.
1. There is a 1.8 x 3.1 cm heterogeneously T2 hyperintense soft tissue lesion extending between the anterior arch of C1 and the dens causing expansion of the atlantodens interval up to 6 mm. This lesion has increased significantly since prior examination. Given the heterogeneity and relatively rapid interval increase in size, malignant degeneration of a nerve sheath tumor should be considered. A CT of the cervical spine with contrast can be obtained to evaluate for bony erosion.2. Expansile lesions in the left hypoglossal canal and left C2-3 neural foramen and likely related to neurofibromas.3. Multiple bilateral jugular chain lesions are consistent with neurofibromas. The largest lesion in the left neck involves the exiting left upper cervical nerve roots and also potentially impinges on these nerve roots. 4. Multiple small probable neurofibromas involving the distal left brachial plexus are demonstrated. No definite right brachial plexus neurofibromas are seen.5. The cervical vertebral bodies are dysplastic with severe kyphosis of the mid cervical spine. 6. A fatty filum terminale is seen. However, the conus terminates at a normal level. The thoracic and lumbar spine appear otherwise unremarkable.