case_images: PMC11696657_01
case_images: Selected thoracic region sagittal (A) and axial (B) images of computed tomography scan -bone window- revealed T6 vertebral body partial collapse with suspicion of an underlying bone lesion (red arrow).
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case_images: A computed tomography (CT) head scan ruled out acute hemorrhagic stroke and a CT angiography of the aorta excluded aortic dissection but spotted a T6 vertebral body compression fracture (Fig. 1).
case_images: Selected images of multiplanar multisequence MRI of thoracolumbar spine with intravenous contrast. Sagittal planes: (A) T2 (B) STIR (C) T1 (D) T1 (D) T1 post contrast. There is T6 vertebral body collapse with underlying abnormal marrow signal of T1 low and T2/STIR bright signal and heterogenous postcontrast enhancement. Element of posterior retropulsion as well as associated prevertebral, paravertebral and retrovertebral intraspinal ventral epidural enhancing soft tissue component at the same T5-T6 level (green dotted line) with moderate cord compression.
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case_images: Histopathology examination. (A) CD1a, (B) CD68, (C) Langerin, (D) S100.
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case_images: Histopathological analysis revealed findings consistent with LCH, with positive immunohistochemical staining for CD1a, langerin, S100, and CD68 (Fig. 3).
case_images: Whole body positron emission tomography. (A) Coronal plane showing asymmetric right-sided parotid gland high uptake (red arrow). (B) Sagittal plane showing mild increased uptake at the area of T6 vertebra consitent with post operative changes. Note the T4-T8 interpedicular screw fixation artefact at mid-thoracic spine.
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case_images: Screening whole body positron emission tomography (PET) CT scan for metabolic assessment showed increased uptake at the area of T6 vertebra, suggestive of residual/active disease, and high right parotid gland uptake (Fig. 4).
case_images: Selected T1 sagittal (A) and coronal (B) images of multiplanar multisequence MRI of pituitary gland without intravenous contrast (avoided due to acute kidney injury), showing mild thickening of the pituitary stalk (red arrows). The width of pituitary stalk measured 4 mm.
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case_images: MRI of the head showed a thickened pituitary stalk (Fig. 5).