Weekly Image Challenge – May 7, 2022

What is the most likely diagnosis for this 35 years old lady who had presented with severe back pain and worsening paraparesis for 2 weeks?

  1. Astrocytoma
  2. Meningioma
  3. Tuberculous abscess
  4. Ependymoma
  5. Metastasis


Congratulations to all those who guessed tuberculosis. The ring enhancing pattern of intradural extramedullary lesion, thoracic location, young age and short history pointed towards an infective pathology, likely tuberculosis. Extradural tuberculous infections usually involve endplates and disc space as well.

Metastasis is a close differential. However, the young age of this patient and absence of tumor elsewhere in the body were against it. Metastasis can be extradural as well as intradural.

Astrocytoma and Ependymoma are intramedullary lesions.

Meningioma is an intradural extramedullary slow growing lesion, with gradual onset of symptoms homogenous contrast enhancement.