0:01

This is a 30-year-old with left-sided back pain.

0:04

On the sagittal scans,

0:05

we may comment about disc desiccation

0:07

and an annular fissure at L5-S1.

0:10

However, when we go into the parasagittal imaging,

0:14

we note that there is a large mass which is present in the

0:17

neuroforamen on the left side, extending into the

0:21

adjacent soft tissues. On the axial scans,

0:24

as we scan inferiorly and look at the levels involved,

0:30

we see that there is this mass which is extending into the

0:34

neuroforamen. Here on our five, four, three, L2-L3 level

0:39

on the left side, which is purely extradural.

0:42

Doesn't really seem to be compressing the thecal sac.

0:46

It extends into the psoas musculature.

0:48

And then, there is an additional extension from the psoas

0:52

muscle into the next lowest neuroforamen at L3-L4.

0:57

This lesion shows contrast enhancement,

1:00

as well as an area of what appears to be

1:03

necrosis, absence of enhancement at these two levels.

1:08

So this is most likely going to be a neurogenic tumor.

1:11

When we look at it,

1:12

we may want to try to characterize it as whether or not it

1:15

shows the target sign of dark signal intensity centrally and

1:19

bright signal intensity. Peripherally, that's not the case,

1:22

and hence we would probably go with Schwannoma,

1:24

since that's more common than neurofibroma,

1:27

except in the patients who have neurofibromatosis Type I.