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