NF 1, pain to percussion and upper and lower thoracic spine. Thoracic: Examination is mildly motion degraded. Vertebral body heights and alignment in the thoracic spine are normal. Lack of contrast and mild motion degradation limiting evaluation for small lesions. However no discrete mass within the thoracic spinal canal or neural foramina is appreciated. Thoracic cord appears normal in signal. There is no significant spinal canal or neural foraminal stenosis at any level. Bone marrow signal is within normal limits. There are multiple T2 hyperintense lesions involving the subcutaneous soft tissues compatible with patient's history of neurofibromatosis. There is a 14 x 34 mm T2 hyperintense lesion involving the musculature at the right upper posterior chest wall which is incompletely evaluated without T1-weighted sequence but may represent a neurofibroma given patient's history.There are trace bilateral pleural effusions.Lumbar: Vertebral body heights in the lumbar spine are normal. Alignment is normal. Within the limitations of noncontrast sequences, no discrete mass within the spinal canal or neural foramina is appreciated. Conus is in normal position. Bone marrow signal is benign. There is no significant spinal canal or neural foraminal stenosis at any level.There is an area of T1, T2, and STIR hyperintensity involving the right lower lumbar and pelvic paraspinous musculature measuring approximately 4.3 x 3.4 cm, axial oblique T2 image 25, with scalloping of the adjacent sacrum and iliac bones. Signal features suggest question of fat within this lesion but not well evaluated. More superficially, in the deep subcutaneous tissues of the right lower back posteriorly there is an area of T1 hypointensity and STIR hyperintensity measuring approximately 1.2 cm x 7.0 cm without mass effect, and suspected to represent an infiltrating neurofibroma.
1. Lack of contrast limits evaluation for small lesions. There is however no discrete mass involving the thoracic or lumbar spinal canal or neural foramina.2. Stigmata of neurofibromatosis 1 with multiple lesions involving the visualized subcutaneous tissues. Relatively larger soft tissue lesions are seen involving the right upper chest wall posteriorly as well as in the right lumbosacral paraspinous region as described above. These may represent neurofibromas given history but would suggest comparison with prior studies to assess stability. 