Investig Magn Reson Imaging.  2017 Jun;21(2):109-113. 10.13104/imri.2017.21.2.109.

Extraforaminal Extrusion of Intervertebral Disc Misdiagnosed as Neurogenic Tumor: a Case Report

• Chun SW
• Park YS
• Heo W
• Baek K
• Moon JI

• KMID: 2385609
• DOI: http://doi.org/10.13104/imri.2017.21.2.109

Abstract

A 55-year-old male presented with dysesthesia of the right anteromedial thigh. A magnetic resonance image revealed a globular mass at the right extraforaminal area of the L3/4 level. Based on the diagnosis of neurogenic tumor, surgical excision was performed. The surgical impression and pathology confirmed extrusion of intervertebral disc. In a retrospective review of the magnetic resonance image, we noticed a fibrillary pattern directed from the intervertebral disc space to the lesion, and disrupted annulus fibrosus and indentation caused by the ring apophysis. We suggest aforementioned features, indicative of intervertebral disc lesions, to be checked when interpreting mass lesions around the intervertebral foramen.

Keyword

Intervertebral disc herniation; Extraforaminal; Extrusion; Neurogenic tumor; Magnetic resonance imaging

MeSH Terms

Diagnosis
Humans
Intervertebral Disc*
Magnetic Resonance Imaging
Male
Middle Aged
Paresthesia
Pathology
Retrospective Studies
Thigh

Figure

• 

  Fig. 1 Axial (a) and sagittal (c) T2-weighted images of the L3/4 disc level show a hyperintense mass (arrows) with a dark signal rim at the right extraforaminal zone. There is a fibrillary pattern originating from the intervertebral disc to the mass (arrowheads in a). Indentation of the mass (star in c) is observed just below the intervertebral disc level (dotted line). A sagittal T2-weighted image obtained at the medial aspect of the mass (f) shows continuity (arrowhead) between the disc and the mass (arrow) with disruption of the annulus fibrosus. Axial (b) and sagittal (e) T1-weighted images show isointensity of the mass (arrow) and hypointense lesion (arrowheads) corresponding to fibrillary pattern in a. Fat-suppressed sagittal T2-weighted image (d) shows hyperintensity of the mass (arrow).

• 

  Fig. 2 Intraoperative photograph (a) shows the mass (white arrow) that is continuous with the disc space. The nerve root (black arrow) is separate from the mass. Photograph after excision of the mass (b) shows an empty cavity of intervertebral disc space (arrow).

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