Paravertebral Lymphoma

contributed by: Dr. Rekha B P
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Findings
Large T1 iso, T2 iso to hypointense lobulated conglomerate lesion measuring 22 x 8 x 9.5 cm (CC x AP x TR) noted involving the pre and left paravertebral location, anterior to the left iliopsoas muscle. The lesion shows significant diffusion restriction and areas of heterogeneous enhancement. Few hypointense, hypoenhancing areas noted within the lesion - ? areas of necrosis.
No invasion/ loss of fat planes with the underlying left iliopsoas muscle.

Superiorly the lesion extends up to the L1 vertebral level and inferiorly extends into the left inguinal region and left proximal thigh.

The lesion is seen to encase left common iliac, left internal iliac, external iliac and common femoral vessels causing smooth compression, however with no evidence of significant luminal narrowing / thrombosis within. Mild wall thickening noted involving the left common femoral and superficial veins, however no complete loss of flow void.

Few bulky discrete paraaortic, aorto-caval and paracaval seen, largest measuring 26 x 25 mm.
Few small discrete left inguinal lymphnodes, largest measuring 9 mm in short axis.

Ill defined T1 isointense, T2 iso to hypointense and STIR hyperintense signal changes involving the marrow of left proximal femur over a length of ~ 6 cm. The lesion shows diffusion restriction and areas of heterogeneous enhancement on contrast. No areas of cortical destruction / periosteal reaction noted.
Diagnosis
? Large heterointense lobulated lesion showing diffusion restriction and heterogeneous enhancement in the left paravertebral location, anterior to the left iliopsoas muscle causing smooth encasement of vessels as described – could suggest conglomerate lymph nodal mass.

? Bulky discrete retroperitoneal lymphadenopathy.

? Ill defined altered marrow signal changes showing diffusion restriction and enhancement involving the marrow of left proximal femur as described – possibly secondary bony lymphoma.
Dr. Rekha B P DNB , DMRD is a Consultant Radiologist from with experience of 3-5 years post-graduated from St. John's Medical College And Hospital, Bangalore. Specialized in Reporting of cases with expertise in
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