Male, 34 years old, with history of neurofibromatosis type I. Assess for any paraspinal neurofibromas. Does flank mass extend to spine. The left-sided paraspinal musculature and flank soft tissues are diffusely infiltrated by T2 hyperintensity which is largely ill-defined but in some areas rather nodular. Given the history, this is compatible with neurofibromas. These lesions begin at approximately the L1-2 level and continue down to the L5-S1 level. The disease is centered within the paraspinal and subcutaneous tissues at L4. Although these lesions extend towards the spinal canal they do not frankly invade it. Numerous additional scattered nodular hyperintense lesions are identified bilaterally in the paraspinal and prevertebral soft tissues. Numerous cutaneous nodules are also demonstrated.The sacral and lower lumbar nerve roots are diffusely nodular and T2 hyperintense compatible with the presence of neurofibromas. These lesions affect both the foraminal and extraforaminal portions of the nerves, but do not extend intracanalicularly. More superiorly, there are small neurofibromas associated with the exiting lumbar spinal nerve roots, particularly at L1-2 on the left.No large intraspinal lesions are detected. The visualized conus and cauda equina nerve roots are unremarkable.L1-2 through L3-4: No significant spinal canal or neuroforaminal stenosis.L4-5: Facet hypertrophy with small facet effusions. Mild bulging disk. No significant spinal canal or neuroforaminal stenosis.L5-S1: Facet hypertrophy. Bulging disk with a superimposed small right paracentral protrusion. The right ventral aspect of the thecal sac is mildly effaced, but no significant generalized spinal canal stenosis is seen. The neural foramina are mildly narrowed.
1.Large infiltrative left paraspinal and flank neurofibroma. This lesion extends towards the spinal canal but does not frankly invade it. 2.Innumerable neurofibromas are evident affecting the foraminal and extraforaminal sacral and lower lumbar nerve roots. Scattered smaller neurofibromas are also seen along the remaining lumbar neural foramina, and within the paraspinal and prevertebral soft tissues.3.No intracanalicular lesions are detected at this time. No areas of spinal canal stenosis are seen. There is a small disk herniation at L5-S1.