Limits...
Neurofibroma, likely neurofibromatosis type I.

Patterson RAP - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Neurofibroma, likely neurofibromatosis type I.

History: 80 year old female with history of low grade lymphoma (ocular MALToma) and meningioma admitted for Left inguinal hernia repair. Found to have abnormal mass on CXR during pre-op evaluation.

Findings: CXR- Normal aeration of the lungs. Multiple sub cm nodular opacities throughout the lungs which correspond to pleural-based nodules on CT. There is a 3.7 x 3.0 cm right paraspinal mass adjacent to the T3-4 vertebral body. No focal airspace consolidation, pneumothorax or effusion. The cardiac silhouette and pulmonary vessels are within normal limits. The aorta is ecstatic, with atherosclerotic calcification. Hiatal hernia noted. Senescent changes are noted in the thoracolumbar spine and bilateral AC joints. CT Chest W/O Contrast- Significant amount of calcification involving the coronary vessels, aorta, and splenic artery. The heart, great vessels, esophagus, large airways and other mediastinal structures are otherwise unremarkable. Small mediastinal lymph nodes are seen which are thought to be within normal limits. Of note, there are multiple sub-clinical axillary nodes present along with a single 1.2cm right axillary lymph node which is at the upper limits of normal. There is a 2.4 x 3.4 cm soft tissue density mass-like lesion seen in the right paraspinous space with apparent extension into the T3-4 intervertebral neural foramina. There is also a 1cm soft tissue nodule seen at the T11-12 paraspinous space on the right side (not seen in the CT slice provided).

Ddx: Neurofibroma vs. Schwannoma vs. Meningioma vs. Sarcoma (bone, cartilage, muscle) vs. Glioma (Ependymoma, astrocytoma, oligodendroglioma) vs. vertebral/spinal cord metastases of Breast, Lung Cancer or recurrent lymphoma (MALToma).

Dxhow: Biopsy

Exam: Gen- Well nourished, Well developed, Awake, Responsive, Oriented x3 HEENT- Normocephalic, supple neck without masses or LAD, PERRLA, Hearing grossly intact, Poor oral hygiene Lungs- Equal BS bilaterally, no rales, rhonchi, wheezes or rubs Heart- RRR, No M/G/R Abd- NABS, Soft, non-distended, TTP in periumbilical area and LLQ Extremities- no clubbing, cyanosis or edema, peripheral pulses palpable and equal. Skin- No lesions, petechiae or decubiti CBC- 6.5 > 12.6 / 38.2 < 220 Lytes- 140 / 4.1 101 / 28 13 / 0.6 < 135 Ca-9.5

No MeSH data available.


CT Chest W/O Contrast-  Significant amount of calcification involving the coronary vessels, aorta, and splenic artery. The heart, great vessels, esophagus, large airways and other mediastinal structures are otherwise unremarkable.  Small mediastinal lymph nodes are seen which are thought to be within normal limits.  Of note, there are multiple sub-clinical axillary nodes present  along with a single 1.2cm right axillary lymph node which is at the upper limits of normal.  There is a  2.4 x 3.4 cm soft tissue density mass-like lesion seen in the right paraspinous space with apparent extension into the T3-4 intervertebral neural foramina. There is also a 1cm soft tissue nodule seen at the T11-12 paraspinous space on the right side (not seen in the CT slice provided).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=MPX2275&req=5

MPX2275_synpic24623: CT Chest W/O Contrast- Significant amount of calcification involving the coronary vessels, aorta, and splenic artery. The heart, great vessels, esophagus, large airways and other mediastinal structures are otherwise unremarkable. Small mediastinal lymph nodes are seen which are thought to be within normal limits. Of note, there are multiple sub-clinical axillary nodes present along with a single 1.2cm right axillary lymph node which is at the upper limits of normal. There is a 2.4 x 3.4 cm soft tissue density mass-like lesion seen in the right paraspinous space with apparent extension into the T3-4 intervertebral neural foramina. There is also a 1cm soft tissue nodule seen at the T11-12 paraspinous space on the right side (not seen in the CT slice provided).


Neurofibroma, likely neurofibromatosis type I.

Patterson RAP - MedPix

CT Chest W/O Contrast-  Significant amount of calcification involving the coronary vessels, aorta, and splenic artery. The heart, great vessels, esophagus, large airways and other mediastinal structures are otherwise unremarkable.  Small mediastinal lymph nodes are seen which are thought to be within normal limits.  Of note, there are multiple sub-clinical axillary nodes present  along with a single 1.2cm right axillary lymph node which is at the upper limits of normal.  There is a  2.4 x 3.4 cm soft tissue density mass-like lesion seen in the right paraspinous space with apparent extension into the T3-4 intervertebral neural foramina. There is also a 1cm soft tissue nodule seen at the T11-12 paraspinous space on the right side (not seen in the CT slice provided).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2275&req=5

MPX2275_synpic24623: CT Chest W/O Contrast- Significant amount of calcification involving the coronary vessels, aorta, and splenic artery. The heart, great vessels, esophagus, large airways and other mediastinal structures are otherwise unremarkable. Small mediastinal lymph nodes are seen which are thought to be within normal limits. Of note, there are multiple sub-clinical axillary nodes present along with a single 1.2cm right axillary lymph node which is at the upper limits of normal. There is a 2.4 x 3.4 cm soft tissue density mass-like lesion seen in the right paraspinous space with apparent extension into the T3-4 intervertebral neural foramina. There is also a 1cm soft tissue nodule seen at the T11-12 paraspinous space on the right side (not seen in the CT slice provided).

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Neurofibroma, likely neurofibromatosis type I.

History: 80 year old female with history of low grade lymphoma (ocular MALToma) and meningioma admitted for Left inguinal hernia repair. Found to have abnormal mass on CXR during pre-op evaluation.

Findings: CXR- Normal aeration of the lungs. Multiple sub cm nodular opacities throughout the lungs which correspond to pleural-based nodules on CT. There is a 3.7 x 3.0 cm right paraspinal mass adjacent to the T3-4 vertebral body. No focal airspace consolidation, pneumothorax or effusion. The cardiac silhouette and pulmonary vessels are within normal limits. The aorta is ecstatic, with atherosclerotic calcification. Hiatal hernia noted. Senescent changes are noted in the thoracolumbar spine and bilateral AC joints. CT Chest W/O Contrast- Significant amount of calcification involving the coronary vessels, aorta, and splenic artery. The heart, great vessels, esophagus, large airways and other mediastinal structures are otherwise unremarkable. Small mediastinal lymph nodes are seen which are thought to be within normal limits. Of note, there are multiple sub-clinical axillary nodes present along with a single 1.2cm right axillary lymph node which is at the upper limits of normal. There is a 2.4 x 3.4 cm soft tissue density mass-like lesion seen in the right paraspinous space with apparent extension into the T3-4 intervertebral neural foramina. There is also a 1cm soft tissue nodule seen at the T11-12 paraspinous space on the right side (not seen in the CT slice provided).

Ddx: Neurofibroma vs. Schwannoma vs. Meningioma vs. Sarcoma (bone, cartilage, muscle) vs. Glioma (Ependymoma, astrocytoma, oligodendroglioma) vs. vertebral/spinal cord metastases of Breast, Lung Cancer or recurrent lymphoma (MALToma).

Dxhow: Biopsy

Exam: Gen- Well nourished, Well developed, Awake, Responsive, Oriented x3 HEENT- Normocephalic, supple neck without masses or LAD, PERRLA, Hearing grossly intact, Poor oral hygiene Lungs- Equal BS bilaterally, no rales, rhonchi, wheezes or rubs Heart- RRR, No M/G/R Abd- NABS, Soft, non-distended, TTP in periumbilical area and LLQ Extremities- no clubbing, cyanosis or edema, peripheral pulses palpable and equal. Skin- No lesions, petechiae or decubiti CBC- 6.5 > 12.6 / 38.2 < 220 Lytes- 140 / 4.1 101 / 28 13 / 0.6 < 135 Ca-9.5

No MeSH data available.