Ventral/Lateral Paraspinal Mass

Jeffrey S. Ross, MD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

ESSENTIAL INFORMATION

Helpful Clues for Common Diagnoses

Lymphadenopathy
- Lymphatic or hematogenous spread
  - Testicular, ovarian cancer
  - Melanoma
  - Prostate, lung, breast
- Direct extension from primary intra-abdominal neoplasms: Pancreas, GI cancers
- Testicular germ cell tumors: Nodes at level of ipsilateral renal hilum
- Metastases
  - Vertebral body involvement with sparing of disc space, with adjacent soft tissue extension
Aortic Aneurysm
- Dilatation of the aorta (Ao) > 1.5x the normal diameter (5 cm ascending Ao, 4 cm arch/thoracic Ao, 3 cm distal abdominal Ao)
- Always measure Ao outer-to-outer borders
- Symptoms: Chest, back, or abdominal pain, distal embolization
Paraspinal Abscess
- Look for associated disc space infection
- Central necrotic foci without enhancement
Retroperitoneal Hemorrhage
- High density collection in retroperitoneal space with fluid-fluid level
- Causes include anticoagulation, aneurysm, & tumor rupture
Meningocele, Lateral
- CSF signal/density meningeal protrusion through neural foramen into adjacent intercostal/extrapleural space
- Strong association with NF1
Neurogenic Tumor
- Schwannoma: Well-circumscribed, “dumbbel”-shaped, enhancing spinal mass centered about foramen