Lower Back Pain

Patient underwent MRI and was diagnosed with neoplasm of chondroid origin. Patient started on radiotherapy but did not improve. Further follow-up CT was performed.

Figure 1. Primary lesion: A well-defined spiculated heterogeneously enhancing soft tissue density lesion of approximate size 22 × 19 × 22 mm (AP × ML × CC) is noted in apical segment in right upper lobe with surrounding lymphangitic spread and endobronchial spread.Metastatic lesion: Lytic sclerotic destruction of L3 vertebra is noted with peripherally enhancing necrotic component measuring 7.7 × 9.1 × 6.4 cm in size involving preverterbral and paraspinal region with multiple foci of internal calcification.

Figure 2. A well-defined altered signal intensity (hypointense on T1WI, heterogeneous on T2WI and STIR, intense heterogeneous enhancement with internal non enhancing necrotic areas on post contrast study) lesion of approximate size (8.7 x 11 x 7.5) cm is noted involving L3 vertebral body and its para-spinal region with epidural component and infiltrating surrounding muscle.

Figure 3. A well-defined altered signal intensity (hypointense on T1WI, heterogeneous on T2WI and STIR, intense heterogeneous enhancement with internal non enhancing necrotic areas on post contrast study) lesion of approximate size (8.7 x 11 x 7.5) cm is noted involving L3 vertebral body and its para-spinal region with epidural component and infiltrating surrounding muscle.

Figure 4. Lumber spine AP view shows an ill-defined sclerotic lesion involving L3 vertebral body with mild reduced vertebral height and increased perivertebral soft-tissue with few calcific foci.

On examination, the swelling was firm and immobile, overlying skin appears normal.

The lesion causes compression over traversing nerve root and bilateral exiting nerve roots.

Posteriorly, it shows epidural component causing severe narrowing of spinal canal with compression of conus medullaris with minimum spinal canal diameter of 2 mm.

The spine is the third most common site for metastatic disease and the most common site for bone metastasis.

Pain is usually localized to the site of metastasis and caused by stretching the pain-sensitive bony periosteum.

During the course of antitumor therapy, progressive sclerosis may be visible on follow-up imaging, indicating positive response to therapy.

Osteoblastic metastases are usually focal or mottled and, in most cases, are multifocal.

The epidural expansion of the tumor may create the “draped curtain sign” which can be depicted on axial MRI slices.

Chondroid matrix mineralization is better demonstrated with CT.

After 1-2 months, patient came for follow-up scan in CT. A tiny lesion was noted on upper lobe of right lung for which FNAC was done. FNAC suggests adenocarcinoma.

spinal lesions on the basis of patient age, lesion location (within the spine and vertebra), and radiologic appearance.