Paraspinal Muscle Abnormality



Paraspinal Muscle Abnormality


Jeffrey S. Ross, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Traumatic Spinal Muscle Injury


  • Muscle Denervation


  • Pseudomeningocele


  • Paraspinal Abscess


  • Tumor, Benign



    • Lipoma, Soft Tissue


    • Hemangioma, Soft Tissue


    • Neurofibroma


    • Schwannoma


Less Common



  • Tumor, Malignant



    • Metastasis


    • Fibrosarcoma, Soft Tissue


    • Malignant Fibrous Histiocytoma


    • Neuroblastic Tumor


    • MPNST


  • Rhabdomyolysis


ESSENTIAL INFORMATION


Helpful Clues for Common Diagnoses



  • Traumatic Spinal Muscle Injury



    • Muscle T2 hyperintensity related to traumatic contusion, laceration, hematoma


    • Muscle may still be functional, even with severe injury


  • Muscle Denervation



    • Asymmetric muscle volume loss with fatty replacement → chronic denervation


    • Acute denervation may show enlargement


  • Pseudomeningocele



    • Spinal cyst contiguous with thecal sac, not lined with meninges


    • CSF-filled spinal axis cyst with supportive post-operative or post-traumatic ancillary findings


  • Paraspinal Abscess



    • Paravertebral enhancing phlegmon or peripherally enhancing liquified collection


    • Ill-defined infiltrative paraspinal soft tissue


    • Obliterated soft tissue fascial plane


    • Low density or ↑ T2 intramuscular collection


  • Tumor, Benign



    • Well-defined soft tissue enhancing lesion


    • Neurofibroma, schwannoma at foramen


Helpful Clues for Less Common Diagnoses



  • Tumor, Malignant



    • Enlarging, heterogeneous, soft tissue mass


    • Look for adjacent bone destruction


    • Any patient with spontaneous musculoskeletal hemorrhage should be evaluated for underlying MFH


  • Rhabdomyolysis



    • Clinical and biochemical syndrome resulting from damage of integrity of skeletal muscle, with release of toxic muscle cell components into circulation


    • Elevated serum creatine kinase (CK) 5x normal value, 100% sensitive


    • Increased T2 signal within affected skeletal muscle group


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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Paraspinal Muscle Abnormality

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