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Unusual Manifestations Of Disc Pathology 2014

Category General Spine Felix Diehn, MD John Wald, MD Jonathan M. Morris, MD Carrie Carr, MD Amy L. Kotsenas, MD Patrick Luetmer, MD Timothy Kaufmann, MD Vance Lehman, MD Kent Thielen, MD Timothy Maus, MD Purpose To illustrate and discuss unusual manifestations of intervertebral disc pathology which interpreting radiologists may encounter and should be able to recognize. Materials & Methods Disc pathology may present with unusual imaging and/or clinical presentations. These include disc herniations in unusual locations, with atypical imaging features, and/or resulting in atypical clinical manifestations. Results Examples of atypical disc herniations to be shown include: extraforaminal-retroperitoneal (including intramuscular and intraneural); dorsal epidural; intradural; intravertebral (Schmorl’s node; and the differential diagnosis, including metastasis); ventral epidural with associated transdural spinal cord herniation (and the differential diagnosis); thoracic; air-containing; FDG avid; associated with epidural hematoma; calcified (including those causing CSF leak and CSF hypotension); and giant. Additional types of uncommon disc pathology include disc-origin fibrocartilaginous embolism causing spinal cord infarct, and discal cyst. Conclusion Beyond familiar disc herniations with typical signs and symptoms, intervertebral disc pathology can have a wide spectrum of imaging and clinical presentations. Radiologists’ knowledge of this broad gamut is important and should improve patient care by enabling accurate diagnoses. References None