Clinical question: Evaluate for disk herniation or compression. Signs and symptoms: Abdominal, flank pain and back pain ( R>L) in T9 distribution. Nonenhanced lumbar MRI:There is normal anatomic alignment the vertebral column however a mild exaggeration of thoracic kyphosis.T1 -- T2 is unremarkable.T2 -- T3 is unremarkable.T3 -- T4 is unremarkable. Examination at this level however demonstrate a right-sided intramedullary mass on the right side of the cord measuring approximately at 3.4 x 4-mm in transaxial dimensions. The mass demonstrate a rim of low T2 signal intensity with internal high signal intensity and without evidence of surrounding edema. The finding is highly suggestive of a small cavernoma. Finding is best appreciated on sagittal T2/T2 stir on image 9 and axial T2 series 5 image 16.T4 -- T5 is unremarkable.T5 -- T6 is unremarkable.T6 -- T7 is unremarkable.T7 -- T8 is unremarkable. Incidental note is made of a focus of T2 hyperintensity and T1 isointense in the dorsal right aspect of T8 vertebrae highly suggestive of a benign capillary hemangioma.T9 -- T10 is unremarkable. Incidental note in this level is also made of a focus of T2 hyperintensity and T1 hypointensity along the superior T10 vertebral body as well highly suggestive of a hemangioma.T10 -- T11 is unremarkable.T11 -- T12 is unremarkable.T12 -- L1 is unremarkable.
1.There is a tiny intramedullary cavernoma in the right aspect of thoracic cord at T4 level as detailed/measured above.2.Examination demonstrates mild exaggeration of thoracic kyphosis.3.There is mild degenerative changes of thoracic spine without evidence of spinal canal or neural foraminal compromise at any level.4.There are multiple small skeletal capillary hemangioma as mentioned above.5.Unremarkable paraspinal soft tissues.6.