Female 54 years old Reason: eval for lumbar spine abnormality History: Hx of Von Hippel Lindau w/ new right sided back pain There is mild kyphosis at the thoracolumbar junction. The vertebral body heights are preserved. Minimal disc desiccation and loss of height of L3-4 and L5-S1. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and terminates at the L1-L2 level. There are innumerable, partially visualized cystic lesions replacing the kidneys bilaterally, some with fluid-fluid levels. Partially imaged cystic lesion in the pelvis, likely left adnexa. Multiple (greater than 10) enhancing nodules along the surface of the conus, from T12 to L1, as well as along the cauda equina nerve roots bilaterally (also present on prior MRI from 2012). The relatively larger nodules along the conus surface are similar to the prior exam (up to approximately 5 mm in diameter), but punctate additional lesions appear new or more prominent, which may be related to technique/contrast timing.Interspace observations:T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is a small right paracentral protrusion, minimally smaller compared to the prior exam, without significant compromise to spinal canal or neural foramina.L2-L3: Minimal disc bulge without significant compromise to spinal canal or neural foramina. L3-L4: There is no significant compromise to spinal canal or neural foramina.L4-5: There is no significant compromise to spinal canal or neural foramina.L5-S1: There is a minimal central protrusion without significant compromise to spinal canal or neural foramina.
1.Multiple, greater than 10, enhancing nodules along the surface of the conus and along the bilateral cauda equina nerve roots which are consistent with multiple hemangioblastomas in the setting of vHL. The relatively larger nodules measuring up to 5 mm are similar to prior MRI from 2012 while some of the smaller punctate lesions appear new or more prominent in the interval. The subtle differences may be related to contrast timing although minimal enlargement remains a possibility.2.Minimal degenerative change without significant spinal canal or neural foraminal stenosis at any level.3.Partially visualized cystic lesions of the native kidneys and left adnexa.