Posttraumatic myelomalacia with syrinx

Findings:

Multiple MR images demonstrate a large expansile cystic lesion of the distal spinal cord which demonstrates no abnormal enhancement on fat saturated T1 post contrast imaging. The expanded spinal cord fills the spinal canal. The cystic lesion demonstrates signal following CSF and there is no signal abnormality of the cord beyond the level of expansion. Multiple remote compression deformities involve many thoracic and lumbar levels, with evidence of previous vertebroplasty at lumbar levels. Severe height loss is seen at L2 associated with retropulsion and mild canal compromise.

Discussion:

When a cystic lesion of the spinal cord is detected, the presence or absence of enhancement is helpful to distinguish between neoplasm and non-neoplastic causes. Nonenhancing cystic malignant neoplasms of the spinal cord have rarely or never been reported. Malignant spinal cord neoplasms almost always enhance. The presence of multiple fractures indicates significant prior trauma, therefore cystic myelomalacia is most likely. The expansile nature indicates that represents a post traumatic syrinx.

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