Age / Sex : 24 / F

Chief complaint: lower extremity weakness with insidious progression during the several years

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)

Courtesy:  김성준(Sungjun Kim), 강남세브란스병원(Gangnam Severance Hospital)

Intradural lipoma (Intramedullary lipoma, subpial lipoma)

Discussion

Findings: A relatively homogeneous, hyperintense mass is seen on both T1 and T2-weighted sagittal MR images. Serial axial T2-weighted images demonstrate intradural location of the mass.

Differential Diagnosis: Dermoid cyst, hematoma

Diagnosis: Intradural lipoma. (Intramedullary lipoma, subpial lipoma are all equally considered as the right answers)

Discussion:

Intraspinal lipomas are most often found in childhood. They are frequently associated with spinal dysraphism and are mainly located in the lumbosacral region. Intradural lipomas without spinal dysraphism represent less than 1% of all spinal cord tumors. Excluding the lumbosacral spine, the reported distribution of lipomas is dorsal in 32% of cases, cervicodorsal in 24% and cervical in 13%. Lipomas most frequently develop posteriorly in the spinal canal and their extent varies from one spinal segment to the entire spine with a mean of six segments (1). It has been reported that the second and third decades of life was most prevalent ages accounting for 55% of all cases in a review (2). The mass typically shows fat signal on all pulse sequences. It barely shows avid enhancement. The differentiation between an intradural, intramedullary, and intradural extramedullary location on image might be difficult (1).

References:

1. Braun P, Serrano FM, Kazmi K, Alvarez-Garrijo JJ. Large subpial lipoma of the dorsolumbar spinal cord in a pediatric patient. Eur J Radiol. 2006; 58(E): 63-67.