Neurofibromatosis, new urinary retention after recent surgery. Thoracic: Again seen is moderate degree of levoscoliosis of the lower thoracic spine, apex at the T10 level. Vertebral body heights are maintained. Bone marrow signal is preserved. No abnormal enhancement or masses within the spinal canal are appreciated. Again seen are multiple masses involving the neural foramina.Right C7-T1 foraminal and extraforaminal enhancing lesion measures 17 x 29 mm, previously 16 x 28 mm and stable to minimally larger.Left T1-T2 paravertebral measuring 32 x 14 mm previously measures 27 x 9 mm. Left T6-T7 lesion not significantly changed. Larger lesion at the left T8-T9 level measures 30 x 24 x 22 millimeters, previous 23 x 23 x 23 mm cyst. Left T11-T12 lesion measures 20 x 16 mm previously 15 x 11 mm. Please note differences in imaging plane and scoliosis limit direct measurement comparisons. Overall however there is minimal enlargement. No significant intraspinal extension or mass effect on the cord is appreciated.Small neurofibromas are again seen in the cutaneous and subcutaneous as well as paraspinal soft tissues overall stable to minimally larger than prior. 6 mm right posterior paraspinous intramuscular lesion at T4 measured 3 mm previously. Trace left pleural effusion similar to prior.Lumbar: Again seen is S-shaped curvature with mild dextroscoliosis at the thoracolumbar junction and levoscoliosis inferiorly with apex at the L3-L4 level. Vertebral body heights are maintained. Again seen are multiple neurofibromas in the lumbar spine with foraminal widening as well as evidence of dural ectasia (particularly in the lower lumbar spine) resulting in widening of the spinal canal.A well-defined tumor along the course of the extraforaminal left L3 nerve root, just deep to the psoas muscle, is not significantly change measuring 12 x 10 mm, previously 11 x 9 mm. On the right side, again seen is ill-defined and infiltrating appearing signal abnormality extending in the paraspinal region along the right L3-4, L4-5 and L5-S1 foramina. This tumor infiltrates the right-sided paraspinal muscles significantly with extension lateral and posterior to the iliac bone, around and within the sacroiliac joint. More anteriorly, tumor extends beneath and displaces the right psoas muscle. Compared to 3/25/2014, there is no significant change in size and extent of this transspatial lesion.There is no evidence of spinal canal stenosis or significant intraspinal extension with any paraspinous/foraminal lesion.Postoperative change is evident in the lower lumbar region with at least partial L3-L5 laminectomies. The conus tip is at the L1 level. Evidence of a spinal de-tethering procedure is seen. There is residual fatty material within the de-tethered filum terminale both at the conus tip and in the distal sacral region as seen before.Numerous small neurofibromas are seen in the cutaneous and subcutaneous as well as paraspinal soft tissues similar to prior.
1. Stigmata of neurofibromatosis type I with stable to mild enlargement of multiple neurofibromas in the thoracolumbar neural foramina and paraspinous soft tissues as detailed above. There is no new lesion within the spinal canal or significant mass effect on the thoracic cord or the cauda equina nerve roots to explain patient's symptoms.2. Evidence of fatty filum terminale and prior cord untethering. If there is significant suspicion for re-tethering related to scar tissue, prone T2 images of the lumbar spine per tethered cord protocol may be helpful.