History: Progressive lower limb weakness. Weight loss.
Findings: The lowest fully-formed disc is taken to represent L5/S1, with a transitional sacrilized L5 vertebral body.
There are extramedullary intradural soft tissue lesions associated with the conus and cauda equina nerve roots that are of intermediate singal on T1 and T2-weighted sequences. The conus is compressed at T12 by one lesion, and the cauda equina is compressed at L1 level by another.
No vertebral bone lesion is identified.
Prominent retroperitoneal and mediastinal lymph nodes are noted on body imaging, and there is a large right-sided pleural collection with lower zone collapse/consolidation and abnormal mediastinal soft tissue. The spleen is heterogeneous with the appearances of multiple ill-defined hypodensities.
Opinion: Intradural extramedullary lesions in the lower thoraculomar region. The presence of lymphadenopathy elsewhere raises the possiblity of intradural lymphoma. Multiple metastases, paragangliomas, nerve sheath tumours, or ependymomas, are also possible diagnoses in this region. Completion imaging of the whole spine with contrast is suggested.