Weekly Image Challenge – July 3, 2022

Have a look at the images of a 79 years old male patient, with no known comorbid, who had presented with a history of progressively worsening paraparesis. What is the most likely diagnosis?

  1. Schwannoma
  2. Metastasis
  3. Meningioma
  4. Epidural hematoma
  5. Epidural abscess


Congratulations to those who chose metastasis. The features favoring this diagnosis include old age of the patient, contrast enhancement, and involvement of the anterior and posterior elements of the vertebra.

Schwannoma can be intradural, extradural, or both, as it follows the nerve, but it does not involve bone.

Meningioma is an intradural lesion based on the dura. It can involve the adjacent bone, but usually, does not involve both anterior and posterior columns.

An epidural hematoma will appear hyperintense on T1 when acute and will follow the signal changes on T1 and T2 images depending on the time since the event. It does not show contrast enhancement.

An abscess can show contrast enhancement, which is often heterogeneous, and it causes destruction of the adjacent bone if that is involved.