case_images: PMC11151400_01
case_images: MRI axial T1-weighted (T1WI), T2-weighted (T2WI) and post-contrast T1 Fat Saturated sequence (T1FS). (a-c) demonstrate an expansile lesion of altered signal intensity involving the body of the L5 vertebra, appearing hypointense on T1WI and T2WI with marked post-contrast enhancement. There is involvement of the left transverse process, left lamina and superior articular processes of the L5 vertebra. (b) The lesion shows multiple fluid-fluid levels with a supernatant hyperintense component and a dependent hypointense component suggestive of haemorrhage (blue arrow). (c) An associated large enhancing soft tissue component is seen involving the prevertebral and paravertebral regions and bilateral erector spinae muscles (red arrow). Anteriorly, the mass is partially encasing the common iliac vessels (white arrow).
case_images: SAJR-28-2839-g001.jpg
case_images: PMC11151400_01_SAJR-28-2839-g001.jpg
case_images: F0001
case_images: On the right, there was extension to the right pedicle, right superior articular process and medial portion of the right transverse process of the L5 vertebra (Figure 1 and 2).
case_images: MRI coronal and sagittal post-contrast T1 Fat Saturated sequence (T1FS) images. The lesion shows marked post-contrast enhancement and is seen encasing the aortic bifurcation and left common iliac vessels (a). Sagittal image showing the cranio-caudal extension of the lesion from the anterior aspect of the inferior endplate of the L3 vertebra to the anterior aspect of the S1 vertebral body (b).
case_images: SAJR-28-2839-g002.jpg
case_images: PMC11151400_01_SAJR-28-2839-g002.jpg
case_images: F0002
case_images: On the right, there was extension to the right pedicle, right superior articular process and medial portion of the right transverse process of the L5 vertebra (Figure 1 and 2).
case_images: Non-contrast CT scan. An ill-defined soft tissue density lesion is seen along the anterior aspect of the inferior endplate of the L3 vertebra to the anterior aspect of the S1 vertebral body and extending laterally from the L5 vertebral body to the right and left paravertebral regions, predominantly on the left side (blue arrow) (a-b). The L5 vertebral body appears sclerotic and shows an expansile destructive lytic lesion involving the vertebral body with complete destruction of the left lateral vertebral body, left transverse process, left pedicle, left lamina of vertebral arch and left superior articular process (red arrow). Posteriorly, the lesion is seen extending between the left iliac crest and left transverse process of the L4 vertebra and is seen compressing the left posterior paraspinal musculature. Anteriorly, the lesion is seen displacing the left psoas muscle laterally (white arrows). A few foci of calcification are seen within the soft tissue mass (circle) (c).
case_images: SAJR-28-2839-g003.jpg
case_images: PMC11151400_01_SAJR-28-2839-g003.jpg
case_images: F0003
case_images: The study revealed an expansile, lytic lesion in the L5 vertebral body with complete destruction of the left transverse process, left pedicle, left lamina and left superior articular process (Figure 3).
case_images: Post-operative MRI Short Tau Inversion Recovery (STIR) coronal, post-contrast T1 Fat Saturated sequence (T1FS) coronal and axial images. (a-c) A persistent expansile lesion is seen involving the body of the L5 vertebra (blue arrow). The lesion shows multiple hyperintense foci on the STIR sequence (a) and heterogeneous post-contrast enhancement on the T1FS sequence (b, c). (b) Residual soft tissue involvement is mainly on the left side (white arrow).
case_images: SAJR-28-2839-g004.jpg
case_images: PMC11151400_01_SAJR-28-2839-g004.jpg
case_images: F0004
case_images: There was a significant reduction of the tumour, as well as in the associated enhancing epidural component and the soft tissue extension in the prevertebral and paravertebral regions (Figure 4).