Multiplanar, multisequential imaging of the lumbosacral spine (A) was obtained without contrast in sagittal, coronal, and axial images. Extensive destruction and erosion of the vertebral bodies within the sacrum were noted, beginning at S2 and extending to S5 ,with destruction anteriorly that affected the posterior elements and went into the sacral ala on the right. The coccyx appeared to be spared.
Published 8/1/2011
In this feature, AAOS Now publishes a series of images, challenging readers to diagnose the condition depicted. The images for this month’s challenge were submitted by Valerae O. Lewis, MD, who provided the following information:
The patient is a 57-year-old man, who complained of pain when sitting. The pain was localized to the sacral region and radiated to the left hip. He also noted pain in the left lower extremity. He denied bowel and bladder problems but noted some diminished sexual function and difficulty maintaining an erection. Conservative treatment was ineffective. Evaluation revealed a mass in the sacrum with some erosion of the sacrum. A small specimen initial biopsy was inconclusive. What’s your diagnosis?
Do you have a challenging case you’d like to submit for publication? E-mail a short case description and any accompanying images to aaoscomm@aaos.org
Multiplanar, multisequential imaging of the lumbosacral spine (A) was obtained without contrast in sagittal, coronal, and axial images. Extensive destruction and erosion of the vertebral bodies within the sacrum were noted, beginning at S2 and extending to S5 ,with destruction anteriorly that affected the posterior elements and went into the sacral ala on the right. The coccyx appeared to be spared.
Multiplanar, multisequential MRI of the lumbosacral spine (B) including coronal views of the sacrum were obtained. The T1-weighted image showed increased signal hyperintensity within the sacrum, beginning at S2 and extending through the sacrum. The T2-weighted images with fat saturation also show slight hyperintensity within the sacrum. The presence of a presacral mass beginning at S2 inferiorly extending through S5 is seen both ventrally and dorsally and is hypointense on the T1 image and hyperintense on the T2 image.
Find the answer to this month’s challenge below.
Answer
This month’s challenge appears concerns a 57-year-old man, who experiences pain when sitting; the pain is localized to the sacral region with radiation to the left hip. The initial evaluation revealed a mass in the sacrum with some erosion of the sacrum, but a small specimen biopsy was inconclusive.
According to Valerae O. Lewis, MD, who submitted the case, the differential diagnosis might include a vascular lesion such as hemangioma, hemangioblastoma, or hemangiosarcoma, or a sarcoma of fatty origin such as a liposarcoma. The correct answer is hemangioma, reports Dr. Lewis.
Do you have a challenging case you’d like to submit for publication? E-mail a short case description and any accompanying images to aaoscomm@aaos.org.