Female, 20 years old, with excruciating upper back pain. Outside report of a T2 lesion and retroperitoneal/mediastinal lymphadenopathy. A compression deformity of the C7 vertebral body results in 60% loss of height, while a compression deformity of the T2 vertebral body results in 70% loss of height. Both vertebral bodies demonstrate pathologic marrow T2 hyperintensity and enhancement. A T2, there is very mild thickening of the ventral epidural soft tissues. This, along with mild retropulsion of the vertebral body, results in a mild spinal canal narrowing. No significant stenosis or cord impingement is suspected. Cord signal characteristics remain normal. The adjacent neural foramina also remain patent.The vertebral bodies of the cervical spine are slender but except as above demonstrate normal morphology and signal characteristics. The vertebral bodies of the thoracic and lumbar spine are unremarkable with no areas of pathologic marrow replacement or enhancement. There is a mild scoliotic curvature of the thoracolumbar spine. Spinal alignment is otherwise unremarkable.The spinal cord demonstrates normal morphology and signal characteristics throughout. No pathologic leptomeningeal or intramedullary enhancement is detected. The conus tip terminates at the L1 level which is normal. No intradural masses are seen.A bulging disk is evident at L5-S1 which results in minimal spinal canal narrowing. The neural foramina are patent. No other significant degenerative disk disease, spinal canal or neuroforaminal stenosis is seen.Views of the paraspinal tissues are notable for the presence of bulky retroperitoneal, and to a lesser degree mediastinal, adenopathy.
Compression deformities of the C7 and T2 vertebral bodies are noted. The presence of diffuse abnormal marrow signal and enhancement at these levels, in the context of significant adenopathy, raises suspicion for pathologic fracturing.Likely etiologies would include both lymphoma and metastatic disease.There may be minimal ventral epidural extension of the disease process at T2. This, along with retropulsion of the T2 vertebral body, results in a mild spinal canal stenosis at this level but without evidence of spinal cord compression.