Neurofibromatosis, type I. Any paraspinal plexiform neurofibromas? Intense pressure on his shoulders and low back pain. Cervical spine: Lack of contrast limits evaluation for small lesions. There is abnormal STIR hyperintensity at the C1-C2 level involving the bilateral C2 nerve roots measuring approximately 12 x 12 mm on the right and 11 x 10 mm on the left, measured in the axial plane. There is minimal epidural component involving the lateral aspects of the spinal canal. There is no spinal canal stenosis at this level or at any level in the cervical spine. No cervical cord signal abnormality or intramedullary expansile lesions.Mild prominence of multiple cervical nerve roots more inferiorly is also noted without large lesions, neural foraminal widening, or epidural extension in the the remainder of the cervical spine. There are mild degenerative changes including minimal disc bulges with dorsal annular fissures at the C4-C5 and C3-C4 levels. Vertebral body heights and alignment are maintained. Bone marrow signal is benign. There is a tubular lesion in the right neck lateral to the right internal jugular vein suspected to represent a neurofibroma. This lesion measures approximately 9 x 30 mm in the transverse and AP dimensions, series 11 image 17) and is centered at the C3-C4 level. Innumerable subcutaneous nodules are also consistent with neurofibromas.Lumbar spine: No discrete mass in the lumbar spinal canal, neural foramina, or paravertebral soft tissues is appreciated. There is a more superficial 8 x 12 mm nodule in the right lower back deep subcutaneous fat at the L4-L5 level, presumably a neurofibroma. There are also numerous more superficial subcutaneous lesions.The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.
1. Likely small neurofibromas involving the C2 nerve roots in the neural foramina bilaterally with minimal epidural extension into the lateral aspect of the spinal canal at the mid C2 level. No spinal canal stenosis.2. No discrete lesions in the lumbar spinal canal or neural foramina. 3. Numerous subcutaneous lesions, as well as a relatively larger 9 x 30 mm lesion in the right neck lateral to the right internal jugular vein at the C3-C4 level as well as an 8 x 12 mm lesion in the deep subcutaneous fat at the L4-L5 level, likely representing neurofibromas.