Upper back pain and dysphagia with NF1. Postsurgical changes of suboccipital decompression for Chiari I malformation are again seen. Optic pathway gliomas are partially imaged.Multiple enhancing masses are redemonstrated in the spine consistent with neurofibromas.Cervical Spine:Vertebral body heights in the cervical spine are normal. There is dural ectasia with dorsal scalloping of the odontoid process. There is also mild loss of normal cervical lordosis. Small disc bulges are evident in the cervical spine without significant spinal canal or neural foraminal stenosis at any level.There is trace prominence of the central canal at the C5-C7 levels measuring 1 to 2 mm and not significantly changed. Otherwise no intramedullary masses are appreciated. No expansile masses within the cervical neural foramina are appreciated.Left lower neck/paraesophageal enhancing mass measures 2.2 x 3.4 x 4.6 previously 2.2 x 3.1 x 4.6 cm. There is very mild mass effect on the esophagus. Left thyroid lobe is anteriorly displaced as is the left common carotid artery.Thoracic Spine:Thoracolumbar scoliosis with posterior spinal fusion hardware are again seen and better assessed on recent radiographs. Neurofibroma involving the right T4-T5 neural foramen is again seen with paraspinous/right posterior mediastinal extension and measures 4.2 x 2.2 cm in the axial plane and 2.5 cm in the craniocaudal dimension, previously approximatelyA left intercostal neurofibroma at T7-8 is incompletely imaged but appears to have enlarged slightly measuring 1.8 cm in thickness previously approximately 1.3 cm in thickness. Lesion measures at least 3.5 cm in the transverse dimension, previously approximately 2.8 cm.Spinal canal and neural foramina in the thoracic spine are otherwise patent. No evidence of mass effect. Distortion related to susceptibility artifact from hardware limits evaluation however no cord signal abnormality or intramedullary tumor is definitively appreciated.Lumbar Spine:Levoscoliosis at the upper lumbar spine is again seen as seen on recent radiographs. Partial osseous fusion involving the upper lumbar vertebral bodies is noted.There are small bilateral paraspinal neurofibromas situated within and adjacent to the psoas muscles, not appreciably changed. There is a left paraspinous mass at the L2-L3 level measuring approximately 20 x 10 mm and unchanged. Small neurofibroma involving the left L5 nerve root suspected not appreciably changed. No discrete mass within the lumbar spinal canal is appreciated within the limitations of susceptibility artifact. Enhancing mass adjacent to the left renal pelvis measuring approximately 2.2 x 2.4 cm is again seen similar to prior and without evidence of hydronephrosis. There is facet arthropathy at L5-S1 with suggestion of a synovial cyst on the left, measuring approximately 7 mm, and abutting the left dorsolateral aspect of the thecal sac without significant mass effect.
1. Compared to 4/8/2013 examination, there has been no significant enlargement of the neck, spinous, or paraspinous multiple neurofibromas. Relatively largest one is seen in the left upper para-esophageal region with very mild mass effect on the esophagus.2. No mass effect on the cervical, thoracic, or lumbar spinal canal is appreciated. No intramedullary mass is appreciated although susceptibility artifact related to spinal fusion slightly limits evaluation. There is trace prominence of the central canal in the cervical cord from C5 to C7 which is not significantly changed.3. There is mild enlargement of a left posterior lateral intercostal schwannoma at the T7-T8 level.4. Please refer to separate report for findings in the pelvis.