Case of the Week 86 Courtesy of Markus Fechler, DC, Heidelberg, Germany
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Case of the Week 86 Case of the Week 86 Courtesy of Markus Courtesy of Markus Fechler, DC, Fechler, DC, Heidelberg, Germany Heidelberg, Germany 56 year old female, who had been a 56 year old female, who had been a regular patient in the office of Dr. regular patient in the office of Dr. Fechler for several years, presented in Fechler for several years, presented in 2007 with excruciating pain down her 2007 with excruciating pain down her left leg and numbness along her left left leg and numbness along her left lateral and anterior thigh that lateral and anterior thigh that prevented her from sleeping at night. prevented her from sleeping at night. She had weakness of her left quadriceps She had weakness of her left quadriceps and psoas muscles and radicular pain at and psoas muscles and radicular pain at L3 and L4 on the left. MRIs were L3 and L4 on the left. MRIs were ordered. ordered.
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Case of the Week 86 Case of the Week 86 Courtesy of Markus Fechler, Courtesy of Markus Fechler, DC, Heidelberg, GermanyDC, Heidelberg, Germany
56 year old female, who had been a regular patient in 56 year old female, who had been a regular patient in the office of Dr. Fechler for several years, presented in the office of Dr. Fechler for several years, presented in
2007 with excruciating pain down her left leg and 2007 with excruciating pain down her left leg and numbness along her left lateral and anterior thigh that numbness along her left lateral and anterior thigh that
prevented her from sleeping at night. She had prevented her from sleeping at night. She had weakness of her left quadriceps and psoas muscles weakness of her left quadriceps and psoas muscles
and radicular pain at L3 and L4 on the left. MRIs were and radicular pain at L3 and L4 on the left. MRIs were ordered.ordered.
What are the abnormal findings? What is the likely What are the abnormal findings? What is the likely diagnosis? How should this be treated?diagnosis? How should this be treated?
A few more MRI slices to A few more MRI slices to appreciateappreciate
AnswersAnswers Abnormal findings:Abnormal findings:
A very large mass is present A very large mass is present surrounding the left L3 nerve root, surrounding the left L3 nerve root, extending into the spinal canal extending into the spinal canal and outside the canal through the and outside the canal through the intervertebral foramen of L3-4. intervertebral foramen of L3-4. The mass displaces the left psoas The mass displaces the left psoas muscle. muscle.
Enlargement of the left L3-4 IVF is Enlargement of the left L3-4 IVF is noted as well as posterior noted as well as posterior scalloping of the left side of L3 scalloping of the left side of L3 vertebral body from pressure vertebral body from pressure erosion. erosion.
Likely Diagnosis:Likely Diagnosis: This is a benign, slow growing This is a benign, slow growing
neurogenic tumour as evidenced neurogenic tumour as evidenced by the pressure erosions on the by the pressure erosions on the adjacent bony structures. The adjacent bony structures. The most likely Diagnoses for this most likely Diagnoses for this ‘dumbbell’ tumour are ‘dumbbell’ tumour are Neurofibroma or Schwannoma.Neurofibroma or Schwannoma.
Treatment:Treatment: Surgery is the treatment as she Surgery is the treatment as she
was in excruciating pain with was in excruciating pain with neurological symptoms.neurological symptoms.
The patient underwent surgery 2 The patient underwent surgery 2 weeks later with a good outcome.weeks later with a good outcome.
