7b (Spine) - Answer: 77-year-old female presents with pain in thoracic spine

HISTORY: 

This 77-year-old female presents with pain in thoracic spine. Adolescent idiopathic scoliosis of thoracic region. Spondylosis of thoracic region without myelopathy or radiculopathy. Spine pain, lumbar. Lumbar facet joint syndrome.


PRIMARY FINDING: 

Renal pelvic mass.


Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


FINDINGS:

Normal vertebral marrow signal intensity. No compression fractures. Normal termination of the conus at T12. Large vascular left renal pelvis and pararenal soft tissue mass requiring attention and further evaluation. Small right hepatic T2 hyperintense lesion. No definite pelvic adenopathy or retroperitoneal adenopathy. 

T12-L1: No compressive discopathy. 

L1-2: No compressive discopathy. 

L2-3: No compressive discopathy. 

L3-4: No compressive discopathy. Shallow concentric disc bulge. 

L4-5: Moderate bilateral facet arthropathy. Congenitally short pedicles. Concentric disc bulge. Mild central stenosis. Mild biforaminal stenosis. 

L5-S1: Severe bilateral facet arthropathy. Shallow central protrusion. Mild biforaminal stenosis. 

The vascular left renal mass was present at that time and is not changed significantly. 

 

CONCLUSION

Dominant finding in this patient with myofascial back pain is a large left renal pelvic mass extending into the paraspinous soft tissues. Highly vascular appearing mass containing a network of vessels. Further evaluation recommended. This mass was present on review of previous scan and is unchanged. Since it contains fat a large angiomyolipoma must be considered along with primary low grade fatty tumor of the renal pelvis.


Discussion
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