What’s the Diagnosis – Case 103
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What’s the Diagnosis – Case 103
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What’s the Diagnosis – Case 103
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What’s the Diagnosis – Case 103
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What’s the Diagnosis – Case 103
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What’s the Diagnosis – Case 103
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What’s the Diagnosis – Case 103
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What’s the Diagnosis – Case 103
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What’s the Diagnosis – Case 103
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What’s the Diagnosis – Case 103
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What’s the Diagnosis – Case 103
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What’s the Diagnosis – Case 103
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Findings On the original study, there is a right paracentral protrusion at L5-S1 and then with a questionable area of abnormal signal adjacent to the right S1 axillary sleeve. On subsequent imaging, a cyst is seen impinging upon the right S1 axillary sleeve. Tissue extends between the cyst and the herniation suggesting a continuity of the two processes.
What’s the Diagnosis – Case 103
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What’s the Diagnosis – Case 103
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Diagnosis: Discal cyst Discal cyst is one of many cysts or cyst like masses that can be present in the lumbar spine. Much more frequent are perineural/Tarlov cysts or synovial cysts emanating from the facet joints. Additionally, at times peripheral nerve sheath tumors can be so T2 hyperintense to look like a cyst. One technical point in this case is that these findings are subtle and as such obtaining images as orthogonal to the disc space or motion segment becomes imperative. The localizer sequence was to indicate that obtaining an additional pulse sequence angled particularly to L5-S1 can be extremely helpful. The etiology of a disc cyst is still debated and likely relates to a cystic degeneration of a disc herniation and that is why demonstrating continuity of the cyst to the disc tissue is important. Alternative theories of etiology relate to hematoma with subsequent liquefaction. As in this case, the cyst may cause mass effect upon neural elements necessitating intervention.
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References Sabri Aydin, Bashar Abuzayed, Hakan Yildirim, Hakan Bozkus, and Metin Vural. Discal cysts of the lumbar spine: report of five cases and review of the literature. Eur Spine J. 2010 Oct; 19(10): 1621–1626.
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