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Extra-spinal Critical Findings on Lumbar Spine Imaging: What the Neuroradiologist cannot afford to miss 2012

General Spine

Dmitry, Goldin, MD
Anant, Krishnan, MD, Non ASSR Member

Poster

Purpose

To review and highlight some examples of critical extra-spinal findings discovered at our institution during lumbar spine imaging.

Methods & Materials

A retrospective review was performed of lumbar spine MR and CT imaging studies in patients in whom extra-spinal findings were discovered that were clinically significant. The examples will be discussed in a case based format, highlighting pertinent history and scenarios that facilitate their identification, and appropriate next step in management. Emphasis will be placed on findings in the retroperitoneum, kidneys and adjacent organs, and other structures that can assessed on routine lumbar spine imaging.

Results

Back pain and radiculopathy are common symptoms that lead to the vast majority of lumbar spine imaging. However there are a number of extra-spinal structures both neurologic and non-neurologic that are imaged either in the diagnostic sequences or on the all encompassing scout images. Failure to discover and appropriately triage these findings may delay treatment or lead to improper care. Some of the cases presented include retroperitoneal, iliopsoas, and pelvic hematomas, acute obstructive renal pathology, renal and adrenal masses, and unexpected lymphadenopathy among others. Review of the appropriate next management step will be discussed.

Conclusion

Awareness of the critical but often incidentally encountered non-spinal pathologies is essential for the practicing neuroradiologist, both in the emergency and out-patient settings.

References/Financial Disclosures

The authors have no financial disclosures.