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Weekly Chest CasesImaging Conference Cases

Case No : 7

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  • Age/Sex 23 / M
  • Case Title admitted for evaluation of skin lesions
  • Figure 1
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Diagnosis With Brief Discussion

Courtesy
K
Imaging Findings
Chest radiograph shows a well defined, round mass in left apical hemithorax and another well-defined, ovoid, soft tissue opacity in right lower thoracic paravertebral area with inferior rib notching, widening of intercostal space and thoracic scoliosis.

On enhanced chest CT scan, the left apical lesion reveals a well defined, round, low density mass in left upper throacic paravertebral area, and the right lower paravertebral lesion reveals low density lesions extending to spinal canal with widening of intervertebral foramen.

Soft tissue in right lower posterolateral chest wall is diffusely thickened.

Myelogram and CT scan after myelography show thoracic lateral meningocele in the levels of three contiguous intervertebral foramen.
Reviewy
1. Aughenbauch GL. Thoracic manifestations of neurocutaneous diseases. RCNA 1984;22:741-756
2. Fraser R, Muller NL, Colman N, Pare PB. Fraser and Pare's Diagnosis of diseases of the chest. 4th ed. W.B. Saunder's Company, Philadelphia, 1999, 688-691,2974-2979
Discussion
Neurofibromatosis is a relatively common hereditary, autosomal dominant, disorders with a frequency of about 1 in 3000 births.

The most prominent manifestations are multiple cutaneous cafe au lait spots and cutaneous and subcutaneous neurofibromas. Neurofibromas can be found in almost any location in the body.

The condition is associated with a variety of neoplasms, including central nervous system gliomas, meningiomas, peripheral nerve sarcomas and schwannomas, pheochromocytomas, and angiosarcomas.

Other findings include interstitial pulmonary fibrosis, lateral thoracic menigoceles, dural ectasia, and skeletal deformities.

Thoracic manifestations of neurofibromatosis include skin and subcutaneous neurofibromas, neurofibromas or schwannoma involving any nerve in the thorax, lateral meningocele, interstitifal lung fibrosis, and thoracic skeletal deformities.

Thoracic neurogenic neoplasms are not uncommon, They can arise in the intercostal nerves and in the mediastinum. CT of neurofibromas and schwannomas shows usually low density mass than muscle, and has not reliably differentiated the two tumors.


Meningocele and meningomyelocele is herniation of the leptomeninges through an intervertebral foramen. Thery occur slightly more often on the right side than on the left, and can be situated anywhere between thoracic inlet and the diaphragm.

They usually detected in middle age. Associated kyphoscoliosis, enlargement of the intervertebral foramen, vertebral and rib anomalies are frequent. Approximately 2/3 of lateral meningocele was associated with neurofibromatosis.

CT does not always differentiate neuroma from meningocele, because the density of both lesions can be identical to that of dural sac contents. Evidence of calcification and enhancement virtually excludes the possibility of a meningocele. Myelography is needed for the definite diagnosis and differentiation of a meningocele for a neural tumor.
Keywords
Paravertebral, Vertebra, Benign tumor,
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