PMC6243371_01
MRI of the lumbar spine. Axial T1 (a-c) and T2 weighted (d-f) MRI showing multiple mass-like lesions (white arrows) in the right paraspinal soft tissues. They show low signal intensity compared with adjacent muscles, both on T1 and T2 weighted sequences. The right paracentral epidural space (a, d) illustrates a small lesion posteriorly dislocating the L5 descending nerve root. In addition, at the L5-S1 level, foraminal/extraforaminal compression of the right L5 nerve root can be seen (b, c, e, f). The right paraspinal muscle lesion (d, e) demonstrates the sedimentation sign of layered calcium in the lesion (white arrowheads).
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The patient then presented to the emergency department of our hospital owing to her persistent symptoms and an MRI of the lumbar spine (T1 and T2 weighted sequences) was obtained (Figure 1).
CT scan of the lumbar spine. Axial CT images with soft tissue window (a-d) showing calcified mass-like lesions in the paraspinal soft tissues at the same locations described on MRI (white arrows). The symptomatic lesions involve the right L5-S1 neuroforamen and have extraforaminal extension. The lesion located at the right paracentral epidural space is not well seen on CT owing to its lower attenuation compared with the other lesions.
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The radiology team suspected that the lesions were calcified and suggested a contrast-enhanced CT scan of the lumbar spine (Figures 2 and 3) to confirm their initial suspicion and rule out possible soft tissue components associated with the lesions.
CT scan of the lumbar spine. Coronal reformatted CT images with bone window (a, b) showing calcified mass-like lesions in the right paraspinal soft tissues (white arrows). It also highlights the foraminal lesions centered on the right facet joint (b) that demonstrates severe degenerative joint disease (black arrow).
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The radiology team suspected that the lesions were calcified and suggested a contrast-enhanced CT scan of the lumbar spine (Figures 2 and 3) to confirm their initial suspicion and rule out possible soft tissue components associated with the lesions.
CT scan of the chest. Axial CT images with lung window (a, b) showing signs of bilateral interstitial lung disease with craniocaudal gradient pattern, compatible with pulmonary fibrosis. Axial CT images with soft tissue window (c, d) demonstrating oesophageal dilatation associated with air-fluid level (white arrows).
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A CT scan of the chest was suggested (Figure 4) and showed signs of pulmonary fibrosis and oesophageal dilatation.