History: 48 years old with progressive weakness
Findings: A spinal cord syrinx extends from C7/T1 to T6/T7, surrounding a solitary expansile intramedullary mass that extends from T3 to T5 levels, with surrounding oedema in the cord itself.
The intramedullary mass is centrally-located, has small regions of cystic change, and enhances, suggesting an ependymoma.
There are spondylotic changes at other levels, including cervical disc-osteophyte complexes that cause mutlilevel neural exit foraminal narrowing, and a circumferential disc bulge at L5/S1 which contacts the descending S1 nerve roots in the lateral recesses.
Opinion: Likely thoracic ependymoma with surrounding syrinx. To exclude other differential diagnoses, such as a cord metastasis, body imaging is suggested.