Cauda equina mass: An Approach

-    CLINICAL PRESENTATION&FINDINGS    57 yr male with h/o low back pain with no h/o trauma presents for MRI lumbar spine which shows – Large relatively well defined , regular, intradural, subtly& heterogeneously enhancing SOL, seen from lower L3 border to middle of body of L5 with compression of cauda equina fibers, displaying mostly soft tissue signals on all sequences / normal meningeal  enhancement, with no significant hemorrhage / fat / cystic / necrosis/ MR demonstrable calcification  components / sugarcoating / scalloping or enlargement of the posterior neural elements/ dumbbell shaped extension across the neural foramina / marrow signal abnormality / soft tissue collections  -intradural neoplastic etiology is possible like astrocytoma (though no significant enhancement) / gangliogloma (though no calcification) / unusual epidermoid (though no cyst ) etc. may need consideration. Other etiology like myxopapillary ependymoma or neuroenic etiologies less likely, in view of enhancement pattern.Case Submitted by Dr MGK Murthy, Dr GA Prasad.Tumors of cauda equina& filum terminal region -Myxopapillary ependymomas arethe most common tumor of the conus medullaris and filum terminale, representing more than 90% of tumors in this region seen in young adults and usually showmarked homogeneous enhancement& may have hemorrhagic areas ( cap sign) & calcifications.Cord edema& nontumoral...

Source: Sumer's Radiology Site - January 12, 2019 Category: Radiology Authors: Sumer Sethi Source Type: blogs