Timothy M. Maus, MD

• Assistant Clinical Professor of Anesthesiology
• Director of Perioperative Transesophageal Echocardiography
• University of California, San Diego
• La Jolla, California

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Diagnostic pearls: Large, well-defined lobulated mass in the center or anterior mediastinum. Diagnostic pearls: Large, ill-defined, lobulated anterior mediastinal mass with heterogeneous attenuation relying on predominant gentle tissue element. Central hypodensities and calcification could occur with heterogeneous contrast enhancement. Mature teratoma is a well-differentiated benign tumor and is the most typical sort. Its major denomination as "malignant teratoma" or "teratocarcinoma" is not used. Overall prognosis is poor, particularly within the presence of mediastinal invasion or pleural/pericardial effusion. Secondary as a end result of diffuse enlargement of thyroid gland and thus contiguous with the organ. Represents 10% of all mediastinal lots; 75% to 80% within the anterior mediastinum, 20% to 25% in the posterior mediastinum. Anaplastic thyroid carcinoma represents 4% to 15% of thyroid malignancies within the seventh decade of life. It is a rapidly enlarging mass inflicting tracheal obstruction and symptoms at an early stage. Diagnostic pearls: Well- to ill-defined anterior mediastinal mass, slightly hyperdense on precontrast scans with a heterogeneous or peripheral postcontrast attenuation. Well-defined, multiloculated cystic anterior mediastinal mass with irregular heterogeneous attenuation and fats deposits. Posterior mediastinal mass with intense but inhomogeneous enhancement and the presence of subtle intralesional calcifications (a). Diagnostic pearls: On postcontrast scans, a low-density mediastinal nodule is seen; visible inside strongly enhancing thyroid tissue if the gland extends as far caudally. Diagnostic pearls: Well-defined spherical and on precontrast scans hypodense mass of 1 to 2 cm resembling a lymph node. Tumor measures between 2 and 26 mm and should happen anyplace from the neck to the mediastinum. Of patients present process surgical procedure for hyperparathyroidism, 22% current with an ectopic parathyroid gland. Medullary carcinoma of the thyroid Ectopic parathyroid gland Neoplastic/other main tumors and tumorlike lesions Lipomatosis. Diagnostic pearls: Diffusely enlarged mediastinum as a outcome of easy, symmetric, typically lobulated accumulation of fat in the mediastinum. Lymph node enlargement is more distinguished in paratracheal, retrocrural, and paravertebral places. Usually symmetric, modest enlargement of mediastinal and bronchopulmonary lymph nodes. Diagnostic pearls: Round, homogeneous lymph nodes with barely elevated attenuation on postcontrast scans. Diagnostic pearls: Size of lymph nodes not indicative of presence or absence of metastases. Calcifications are observed in metastases from cartilaginous or osseous tumors, mucinous adenocarcinoma, or bronchoalveolar carcinoma. On postcontrast scans, pronounced enhancement is noticed in metastatic lymph nodes of renal, thyroid, and choriocarcinoma. Usually associated with Cushing syndrome or long-term corticosteroid therapy, occasionally with simple weight problems. Any (near) spherical lymph node with a ratio of shortest/longest diameter close to 1 and with out central fats pad is highly suspicious, particularly if measuring 10 mm in dimension. Other common primaries are head and neck tumors, breast cancer, renal carcinoma, and malignant melanoma. Hyaline vascular sorts are usually localized and asymptomatic; plasma cell types, multicentric and symptomatic. In 70% of cases, involvement of only the thorax; in 15%, additionally in the neck and/or abdomen.

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Subchondral amyloid deposition may lead to avascular necrosis caused by perivascular amyloid deposition with subsequent vascular occlusion. Subchondral cyst formation and erosions in the hand and wrist (especially carpal bones) associated with periarticular or diffuse osteoporosis might simulate rheumatoid arthritis, although intensive nodular gentle tissue plenty, well-defined cystic lesions with or with out surrounding sclerosis and preservation of the joint area are more characteristic for amyloidosis. Single or a quantity of, occasionally expansile, well- to poorly defined osteolytic lesions of the axial and appendicular skeleton. Brown tumors may undergo necrosis and liquefaction, producing cysts, or with correct treatment (removal of the parathyroid adenoma) turn into more and more sclerotic. Central (intraosseous) or eccentric (subperiosteal), well-demarcated osteolytic lesion, typically related to cortical violation, a stable or interrupted periosteal response, and a big gentle tissue mass is a typical presentation. Minimal to large calcification within the lesion is sometimes also encountered. One or more cystic lesions typically with partial calcification could additionally be found in the subchondral and deeper osseous areas simulating enchondromas. Eosinophilic granuloma is each the commonest and most benign variant, representing about 70% of cases. Spontaneous healing of a solitary lesion happens, typically progressing from the periphery towards its middle, and eventually resulting in its disappearance or transformation in to a sclerotic focus. Hand�Sch�ller�Christian disease is characterized by the triad of exophthalmos, diabetes insipidus, and enormous lytic skull lesions ("geographic skull"). Letterer�Siwe illness is the acute disseminated variant in kids younger than 2. Bone lesions are less widespread however might embody a number of widespread lytic lesions within the cranium ("raindrop" pattern). Hepatosplenomegaly, lymphadenopathy, and nonitching eczematous pores and skin lesions are generally associated. Secondary amyloidosis is associated with persistent renal illness, rheumatoid arthritis, lupus erythematosus, ulcerative colitis, chronic suppurative illness, and lymphoproliferative disorders. Other manifestations of hyperparathyroidism are often also apparent and include osteopenia, subperiosteal, endosteal, and subchondral bone resorption, intracortical tunneling, chondrocalcinosis, and paraarticular calcifications and vascular calcifications. Lesions are late sequelae of intramedullary or periosteal hemorrhage/hematoma occurring in 2% of hemophiliacs. Hemophilic arthropathy, including dense joint effusions and joint contractures, avascular necrosis, especially of the femoral head and talus, spontaneous fractures, and soft tissue hematomas, may also be evident. Intraosseous urate deposition with subsequent calcifications usually originates from the adjoining joint, penetrates the cartilaginous floor, and extends in to the spongiosa. An eccentric lesion is seen within the midshaft of the femur with cortical destruction, gentle tissue extension, and periosteal response. Diffuse lytic and sclerotic involvement of the vault and base of the skull is seen. Vertebral manifestations embody a poorly defined osteolytic lesion (a), a well-demarcated osteolytic lesion with a sclerotic border (b), and a vertebra plana (c). Expansile lesion with central calcification is seen within the left ilium of a patient with von Willebrand illness. In the diametaphyses, they embrace serpiginous peripheral rim of calcification or sclerosis surrounding an rectangular space of bone rarefaction. Intramedullary calcifications are often the one finding and are usually shell-like and peripheral, whereas the calcifications in chondroid matrix tumors are inclined to be punctate, ringlike or irregular and central and are surrounded by a rim of noncalcified, radiolucent tumor matrix. Solid periosteal reactions and cortical thickening could additionally be associated with each conditions, but in the case of chondroid matrix tumor counsel a low-grade chondrosarcoma somewhat than enchondroma. Typical findings of osteonecrosis in the epiphyses (avascular necrosis) embrace curvilinear subchondral sclerosis, subchondral cyst(s) with sclerotic rim, arclike subchondral radiolucency (crescent sign), subchondral fragmentation, and finally collapse of the articular surface, with appreciable sclerosis and secondary degenerative modifications within the affected joint. Comments Osteonecrosis may be divided in to bone infarction, occurring extra incessantly within the metadiaphyseal regions of long bones. Osteonecrosis may be idiopathic (25%) or related to hematological and reticuloendothelial illnesses.

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The source of infection is normally odontogenic, however sublingual or submandibular sialadenitis, trauma, and surgical procedures of the ground of the mouth are additionally causes of infection. Patients between the ages of 20 and 60 y (rarely seen in children) usually present with rapidly progressive facial swelling and induration, oral ache, fever, trismus, dysphagia, dysphonia, and dyspnea. Odontogenic an infection is most often brought on by periapical or periodontal illness related to poor oral hygiene or by extraction of a carious tooth. Odontogenic an infection might result in cellulitis, myositis, fasciitis, osteomyelitis, and abscess formation. Odontogenic infections of the maxillary molars might prolong in to the buccal and masticator spaces. Further spread occurs in to the retromolar trigone, parapharyngeal, and submandibular areas and the ground of the mouth. Infections arising from the lower second and third molar enamel (the roots of which attain under the attachment of the mylohyoid muscle) unfold in to the submandibular area. Common associated findings are extensive adjacent tongue and gentle tissue cellulitis, edematous subcutaneous skin modifications with stranding and dermal thickening, increased density of fatty tissue with streaky, irregular enhancement (edematous, "dirty" fat), thickening and enhancement of fasciae, muscular enlargement with enhancement (myositis), and reactive or suppurative adenopathy of submandibular lymph nodes. Seven % of these benign, heterogeneous tumors arise spontaneously from minor salivary glands that usually line all surfaces of the upper aerodigestive tract. The affected person typically presents with a slowly enlarging, painless submucosal tumor. Malignancy may develop in 2% to 10% of lesions (carcinoma ex pleomorphic adenoma). Malignant neoplasms Squamous cell carcinoma of the oral cavity Squamous cell carcinoma accounts for 95% of all neoplasms of the oral cavity. Clinical tumor stage of oral cavity carcinoma: T1: Tumor is 2 cm in its greatest dimension. T4a (oral cavity): Tumor invades via cortical bone, in to deep/extrinsic muscle of tongue, maxillary sinus, or skin of face. T4a (lip): Tumor invades by way of cortical bone, inferior alveolar nerve, floor of mouth, or pores and skin (chin or nose). T4b: Tumor invades the masticator space, pterygoid plates, and cranium base or encases the internal carotid artery. Thirty to 70% of oral cavity squamous cell carcinomas have malignant lymph nodes at presentation. Bone erosion usually happens along the buccal surface of the mandibular or maxillary alveolar ridge. Large tumors might prolong directly in to the mandible or contain the psychological nerve without cortical bone destruction. Lower lip lesions metastasize to the submental and submandibular lymph nodes, upper lip lesions to the preauricular, submental, and submandibular lymph nodes. Squamous cell carcinoma of the oral tongue: Variably enhancing, infiltrative, ulcerative, and/or exophytic mucosal mass lesion, often originating along the lateral border or ventral floor of the anterior two thirds of the tongue (lingual tonsil is part of the oropharynx). Advanced tumors tend to develop in to the glossotonsillar sulcus, base of the tongue, tonsillar fossa, ground of the mouth, and submandibular house, to cross lingual septum to the alternative half of the tongue, or could invade the mandible. Forty to 70% of patients have regional adenopathy (submandibular nodes, high and midjugular nodes, or lower jugular nodes) at presentation, half of those bilaterally. Carcinoma of the oral tongue is the second commonest web site of oral cavity most cancers (20% of all oral carcinomas). Predisposing factors are poor oral hygiene, tobacco and alcohol use, preexisting Plummer�Vinson syndrome (Scandinavian women), and the coincidence of syphilis. Involvement of the lingual nerve is liable for the pain within the ipsilateral ear. Most tumors originate within the anterior portion of the ground of the mouth barely off the midline. Inferior spread happens in to the sublingual house and may result in obstruction of the submandibular duct and continual irritation or infection of the submandibular gland. Infiltration in to the mylohyoid muscle signifies involvement of the submandibular house.

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Large ill-defined hypodense lesion in the right liver lobe, with noncompromising hepatic vessels. Sharply outlined band of diminished density within the liver similar to the radiation port. Large hemangiomas seem more heterogeneous and may comprise central fibrotic cleft of low density. Hemangiomas normally are isodense to blood and thus show an analogous enhancement pattern because the aorta. Hemangiomas grow slowly from childhood to adulthood, extra rapidly throughout pregnancy. Low-density band (arrow) inside the porta hepatis surrounding the branches of the portal vein. Heterogeneous subcapsular hypervascular lesion, on common 8 to 15 cm in diameter, with a preference for the right lobe of the liver and surrounded by a pseudocapsule. Pseudocapsule appears hyperdense as compared with regular liver parenchyma and adenoma. Comments Rare benign liver tumor most frequently seen in girls between age 20 and 50 y. Absence of intratumoral calcifications, necrosis, and hemorrhage might assist to differentiate from these lesions. Multilocular adenomas (hepatic adenomatosis) seen in patients with glycogen storage illness or diabetes mellitus. Histologically, adenomas lack bile ducts and portal/central veins however include hepatocytes which may be organized in cords/sheets. Diagnostic pearls: Multiple small lesions with similar near-water attenuation on pre- and postcontrast scans. Diagnostic pearls: Well-delineated, homogeneous, round, near-water density lesions without enhancement after contrast utility. Comments Histologically, regenerative nodules consist of hyperplastic hepatocytes surrounding dilated, atypically shaped, massive sinusoids. Associated with von Hippel�Lindau illness, polycystic kidney disease, and autosomal dominant polycystic liver illness. In case of septations, irregular inner margins, intracystic components, and distinction attenuation rule out cystic neoplasm. Histologically, composed of fat, easy muscle cells, and proliferating blood vessels. May be distinguished from focal steatosis (poorly discernible, blood vessels crossing via lesions) and metastases from liposarcoma (heterogeneous lesions with distinct attenuation on postcontrast scans). Round intrahepatic cystic mass or tubular lucencies simulating dilated bile ducts (see also. Intrahepatic extension of a pancreatic pseudocyst (continues on web page 688) Focal Liver Lesions 687. Sharply delineated, spherical or oval lesion of near-water attenuation with out distinction enhancement of the cyst wall. Well-defined, giant, solitary heterogeneous mass; often hypodense central scar and radial septa. Either hypo- (common) or hyperdense (less common) lesions with random distribution sample inside normal-enhancing liver tissue. Metastases of ovarian cystadenocarcinoma usually infiltrate liver from outdoors and thus may be discovered primarily in a subcapsular location. Predisposing conditions: cirrhosis as a outcome of ethanol or virus hepatitis, hemochromatosis, Wilson illness, Gaucher disease, glycogen storage illness (type 1), tyrosinosis, and biliary atresia. Lymph node/lung metastases and biliary/vessel infiltration are signs of malignancy. Most common liver malignancy (20 instances extra frequent than all major liver neoplasms combined).

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In hydatid (echinococcal) disease, a bigger partially calcified cyst with a thin or thick wall containing daughter cysts is diagnostic. Amorphous or punctate calcifications associated with a strong or partially cystic mass are present in a big selection of benign. Diffuse renal parenchymal calcifications (nephrocalcinosis) happen most frequently in the renal medulla, especially within the renal papilla, the place the biggest urine concentration is attained. Medullary nephrocalcinosis is discovered with medullary sponge kidney, hyperoxaluria, and situations associated with hypercalcemia and hypercalcinuria. Cortical nephrocalcinosis is uncommon and limited to diseases primarily involving the renal cortex. Nonopaque calculi account for approximately 10% of all renal calculi and encompass uric acid, xanthine, or matrix (mucoprotein/mucopolysaccharide). Perinephric fluid collections complicating a renal transplant are caused by lymphocele, urinoma, hematoma, and abscess formation. Lymphoceles are the commonest peritransplant fluid collections, characteristically occurring within 2 to three weeks after transplantation. A well-demarcated, hypodense lesion mimicking a cyst is obvious within the lateral aspect of the left kidney on this contrast-enhanced scan. A large fluid collection (arrow) is visible in the right hemipelvis after renal transplantation. The density of the lymph within the lymphocele is just like the urine in the adjoining distended bladder. Urinomas can occur at any time after transplantation and are brought on by an anastomotic leak or are secondary to a vascular injury causing a focal necrosis with subsequent leak in the urinary system. Nevertheless, a fast improve within the dimension of a failing transplant suggests acute rejection. The differentiation of focal lesions in the kidney and perinephric area is mentioned in Tables 27. In horseshoe kidneys, the lower poles of each kidneys are fused by a parenchymal or fibrous isthmus throughout the midline at L4�L5 between the aorta and inferior mesenteric artery. The lengthy renal axis is medially oriented, and renal pelvises and ureters are located anteriorly. Comments In longitudinal ectopy, the kidney is malpositioned in any location from the thorax to the sacrum. Pelvic kidney is the most common location and incessantly related to vesicoureteral reflux, hydronephrosis, hypospadia, and contralateral renal agenesis. In crossed ectopy, the malpositioned kidney is usually fused with the contralateral kidney. A giant kidney with usual define and two collecting methods on one aspect and an absent kidney on the contralateral facet are diagnostic. In renal fusion, the fused kidneys are situated in the midline and should assume the form of a horseshoe, disk, or pancake. Differential prognosis: A malpositioned kidney may be caused by a big adjoining mass. In full renal and ureteral duplication, the ureter draining the upper system inserts ectopically medial and beneath the orthotopic ureter in to the bladder trigonum or urethra and could also be related to an ectopic ureterocele. Other congenital renal anomalies are partial duplication, supernumerary kidney, and renal hypoplasia or agenesis. Upper pole moiety is subject to obstruction and will simulate an upper pole mass on excretory urography when utterly obstructed. The lower poles of both kidneys are fused by a parenchymal isthmus, with the renal pelves and ureters being located anteriorly. The right kidney is rotated and displaced medially by a big proper retroperitoneal abscess containing an extended air�fluid level. Differential analysis: renal duplication the place either the higher or lower pole moiety is malfunctioning. It might lead to concentric encroachment of the renal collecting system (trumpetlike pelvocaliceal system on urography), but with out obstruction. Dilated accumulating system evident as water-density construction within normal or enlarged kidney on nonenhanced photographs. After enhancement, a persistent nephrogram and delayed and decreased distinction medium excretion are attribute.

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A relatively poorly defined mass with inhomogeneous, hypodense central areas is obvious in the thigh. Bilateral barely inhomogeneous lesions (arrows) adjoining to the posterolateral chest wall just beneath the inferior scapular angles are seen. A well-defined oblong soft tissue mass (a) is seen in the best posterolateral abdominal wall (arrow). A extra aggressive lesion (b) is clear as a poorly outlined delicate tissue density within the left anterior stomach wall (arrow). Well-circumscribed, considerably irregular outlined lesions (b) with hypodense facilities are seen in the right anterior stomach wall. Well- or poorly defined, inhomogeneous soft tissue mass, usually with necrotic (hypodense) areas and considerable contrast enhancement. A periosteal response is, nevertheless, uncommon unless a pathologic fracture has occurred. Histologically, five different types (well-differentiated, embryonal, myxoid, pleomorphic, and spherical cell) are recognized. With the exception of the well-differentiated liposarcoma, these neoplasms are extremely malignant. Fibrosarcomas have related radiologic and histologic options but appear general barely much less malignant. In adults, the tumor is normally situated within the deeper tissues of the extremities and torso. The benign rhabdomyoma is an especially uncommon tumor of benign striated muscle cells. These neoplasms are most often found in the retroperitoneum or thigh or could also be related to main blood vessels. Relatively poorly outlined, usually inhomogeneous mass with calcifications in 30% and erosion/destruction of adjacent bone without reactive sclerosis in 20% of instances. A fatty mass (a) containing irregular delicate tissue components is seen in the thigh. A well-circumscribed ovoid mass (b) containing only small quantities of fatty tissue in its center is seen posterior of the spine. A relatively well-defined heterogeneous mass (c) containing solely a small amount of fatty tissue is seen in the anterior thigh. A subcutaneous lesion with a hypodense heart and adjoining nodular thickening of the pores and skin is seen. A large pear-shaped mass with a hypodense (necrotic) middle is seen lateral to the proper pelvis. A poorly outlined mass with multiple irregular calcifications and slightly lower attenuation than the adjoining muscular tissues is seen posterior to the knee (a) and in the semimembranosus muscle of the thigh (b). In tuberculous spondylitis, a fusiform psoas abscess with amorphous or teardrop-shaped calcifications is usually associated. Presence of soppy tissue fuel in the absence of surgical or percutaneous intervention is uncommon however virtually diagnostic. Homogeneous enlargement of the involved muscle, which might be hyperdense in the acute stage. In the subacute stage, the hematoma may be poorly defined and is both isodense or slightly hypodense. A "hematocrit effect" caused by settling of the cellular parts inside the liquefied hematoma is sometimes observed. Round delicate tissue density with often curvilinear calcification within the neighborhood of a major artery. Aneurysm/ pseudoaneurysm Popliteal artery aneurysm is the most common aneurysmatic lesion found within the extremities and presents as a pulsatile mass. A lobulated, relatively well-defined gentle tissue mass is seen in the thigh (arrow). A well-defined, slightly inhomogeneous mass arising from the intercostal nerve tasks between the posterior chest wall and liver (arrow).

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Diagnostic pearls: Wedge-shaped, initially ill-defined, pleura-based consolidation with apex pointing towards the hilum (Hampton hump). Diagnostic pearls: Well-defined, spherical or lobulated mass in shut proximity to the left atrium, as nicely as distinction enhancement simultaneous with the left atrium. Diagnosed often in early adulthood both as an isolated anomaly or associated with Rendu�Osler�Weber syndrome (hereditary hemorrhagic telangiectasia). Inflammation Amyloidosis A variety of situations in which amyloid proteins are abnormally deposited within the lung. Diagnostic pearls: Tracheobronchial sort: Endobronchial nodules with obstructive airway illness. Nodular sort: Solitary or a number of nodules, partly with cavitation and/or calcification. Diffuse parenchymal type: Diffuse interstitial disease of miliary or reticulonodular nature. Conglomerate plenty ranging within the center and higher lung zones and associated with a wide range of pneumoconiosis. Mass seems spindle-shaped, with a shorter anteroposterior and a longer mediolateral diameter. Histologically, deposition of fibrils of light-chain immunoglobulins in perivascular distribution. Primary amyloidosis (amyloid L) associated both with no illness or with a number of myeloma. However, in sarcoidosis, huge fibrosis can also present as a central homogeneous mass or giant nodular lesions with irregular margins. A barely lobulated subpleural mass is seen on the left side with a feeding vessel. Wedge-shaped pleura-based consolidation dorsally in the best decrease lobe (a) with corresponding pulmonary artery embolus (b). Diagnostic pearls: Multiple, usually sharply outlined, bilateral nodules starting from 1 to 10 cm and generally discovered within the lower lung zones; presence of "feeding" vessels getting into the nodules; usually thick-walled and nonregular cavitation that may progress in to thin-walled cavities. Diagnostic pearls: Solitary or a number of, wellcircumscribed, peripheral nodules measuring from 5 mm to 5 cm in diameter. Solitary or a quantity of cystic lesions due to obstructive overinflation related to acute pneumonia. The lymphomatoid variant of Wegener granulomatosis sometimes spares the paranasal sinuses. Allergic granulomatosis (Churg�Strauss syndrome) presents as both multinodular illness or nonsegmental air-space consolidation in peripheral distribution, just like eosinophilic pneumonia. Differential analysis: polyarteritis nodosa and necrotizing sarcoid granulomatosis, which may additionally current as multinodular illness. Traumatic pneumatoceles (pneumatocysts) could occur after toxic gas inhalation or blunt chest trauma. Similar inflammatory mass lesions but without fat entrapment are found with stable or liquid aspirations aside from oil and in postobstructive pneumonitis. Diagnostic pearls: Irregular mass or areas of consolidation containing regions of fat; often referred to as inflammatory pseudotumor. Diagnostic pearls: Well-defined heterogeneous mass in a posterior basal decrease lobe phase, usually contiguous with the diaphragm; abnormal feeding vessels come up from the aorta, its aspect branches, or intercostal arteries. Often single multicystic with or with out air�fluid levels because of infection ensuing from communication with the bronchial tree. Diagnostic pearls: Solitary or a quantity of, thin- or much less commonly, thick-walled cystic mass; occasional presence of air�fluid levels; within the majority of cases, unilateral lung involvement with contralateral shift of the mediastinum. Absence of abnormal feeding and draining vessels might differentiate this situation from sequestration. Intralobular sequestration usually presents in adulthood and is related to other congenital anomalies (10%). Extralobular sequestration (20% of all sequestrations) characteristically presents as a homogeneous noncavitating mass in neonates usually related to other congenital anomalies.

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Coronal (a) and axial (b) images show burst fractures of adjacent thoracic vertebrae. Sagittal (a) and axial (b) pictures exhibits horizontally oriented fracture planes by way of the vertebral body and posterior components. Sagittal pictures in two sufferers present horizontally oriented fracture planes via the vertebral physique and posterior parts in sufferers with ankylosing spondylitis ("bamboo spines"). Epidural assortment with low to intermediate and/or slightly high attenuation, with or without spinal cord compression, with or with out minimal peripheral sample of enhancement at hematoma. Comments Neoplasms in bone are related to bone destruction and decreased functionality for sustaining integrity with axial loading, in addition to lowering the edge for fracture with minor trauma. Can be spontaneous or outcome from trauma or complication (coagulopathy, lumbar puncture, myelography, and surgery). Represents a disk herniation (focal broad-based) that results from inside annular disruption or subtotal annular disruption with extension of nucleus pulposus towards annular damage with expansive deformation. Represents a disk herniation (focal broadbased) with extension of nucleus pulposus via zone of annular disruption with expansive deformation. Disk herniation/extruded disk fragment� herniation/extrusion: Herniated fragment of nucleus pulposus with out connection to disk of origin. Disk herniations could be midline, off-midline in lateral recess, posterolateral within intervertebral foramen, lateral, or anterior. Can lengthen superiorly, inferiorly, or both instructions; with or without related epidural hematoma, with or without compression or displacement of thecal sac and/or nerve roots in lateral recess and/or foramen. Disk herniations can occur in to the tip plates of vertebral bodies, Schmorl nodes. Disk herniation/extrusion: Disk herniation during which the head of the disk herniation is bigger than the neck on sagittal reconstructed images. Sagittal picture reveals an osteosclerotic and osteolytic metastatic lesion, as properly as a pathologic fracture involving the T1 vertebral body. Epithelial-lined tube extending internally from the dorsal skin of decrease again, with or with out extension in to spinal canal by way of the median raphe or spina bifida, with or with out related dermoid or epidermoid in spinal canal (50%). Well-circumscribed, spheroid or multilobulated, intradural extramedullary or intramedullary lesions, often with low to intermediate attenuation. Well-circumscribed, spheroid or multilobulated, intradural or extramedullary lesion with low to intermediate attenuation No distinction enhancement. Tarlov cysts (perineural cysts) Dorsal dermal sinus Abnormality ensuing from lack of regular developmental separation of superficial and neural ectoderm. Nonneoplastic congenital or acquired ectodermal inclusion cystic lesions filled with lipid materials, cholesterol, desquamated cells, and keratinaceous debris; normally delicate mass impact on adjoining spinal twine or nerve roots; adults: M F; with or with out related clinical signs. Nonneoplastic extramedullary epithelial-inclusion lesions filled with desquamated cells and keratinaceous debris; usually mild mass effect on adjacent spinal wire and/or nerve roots. May be congenital (with or without associated with dorsal dermal sinus, spina bifida, and hemivertebrae) or acquired (late complication of lumbar puncture). Results from developmental failure of separation the notochord and foregut; noticed in sufferers older than 40 y. Location: thoracic cervical posterior cranial fossa craniovertebral junction lumbar; usually midline in place and sometimes ventral to the spinal wire. Neoplasm and other lots Ependymoma Intradural, circumscribed, lobulated lesions at conus medullaris and/or cauda equina/filum terminale, hardly ever in sacrococcygeal soft tissues; lesions often have intermediate attenuation, with or with out hemorrhage. Ependymomas at conus medullaris or cauda equina/filum terminale usually are myxopapillary sort, thought to come up from ependymal glia of filum terminale. Usually are slow-growing neoplasms related to lengthy period of again pain, sensory deficits, motor weakness, and bladder and bowel dysfunction; with or without persistent erosion of bone with scalloping of vertebral bodies and enlargement of intervertebral foramina. Encapsulated neoplasms arising asymmetrically from nerve sheath; most common type of intradural extramedullary neoplasms; usual presentation in adults with pain and radiculopathy, paresthesias, and lower extremity weak spot. Meningioma Extra- or intradural extramedullary lesions, intermediate attenuation, with distinction enhancement, with or with out calcifications.

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