MyPACS.net: Radiology Teaching Files > Case 3205826

never visited THORACIC HNP + IDIOPATHIC DISC CALCIFICATION
Contributed by: Fritsch & Thompson.
Patient: 44 year old male
History: 44 year old male with thoracic pain.
Images:[small]larger

Fig. 1: Central calcification T7-T8 disc space noted on AP plain film

Fig. 2: Lateral thoracic spine xrays showing calcification of T7-T8 disc.

Fig. 3: Lateral xray close-up

Fig. 4: Mid-sagittal FSE T2 MRI: calcification shows signal void in T7-T8 disc.

Fig. 5: Mid-sagittal FSE T2 MRI: calcification shows signal void in T7-T8 disc.

Fig. 6: Right paramedian FSE T1 sagittal MR slightly right of midline shows HNP at the T8-T9 level

Fig. 7: Right paramedian FSE T2 sagittal MR slightly right of midline shows HNP at the T8-T9 level

Fig. 8: Mid-sagittal FSE T1 showing T7-T8 calcified disc.

Fig. 9: Mid-sagittal FSE T2 showing T7-T8 calcified disc.

Fig. 10: FSE T1 showing paramedian T8-T9 HNP.

Fig. 11: FSE T2 showing paramedian T8-T9 HNP.
Findings: Plain films are unremarkable except for idiopathic calcification in the central portion of the T7-T8 disc space and some mild degenerative changes. MRI examination reveals the most likely cause of the patient's back pain- a right posterolateral HNP of the T8-T9 intervertebral disc causing mild displacement of the thoracic cord.
Diagnosis: Thoracic T8-T9 disc herniation (protrusion) with incidental finding of calcification of the T7-T8 disc.
Discussion: Isolated calcification of the nucleus pulplosis is often idiopathic, possibly related to a previous trauma. More widespread involvement may occur with metabolic abnormalities, such as ochronosis.
References:

Case Of the Week: 11/16/2005

MRI Case of the Week: 07/26/06

Comments:
Calcification in this thoracic HNP indicates that there is a chronic component to this pathology. Surgical approaches to thoracic disc herniation are reserved as options of last resort after conservative treatments. The ribs act as self-supporting structure, much like an external brace brace would be in the cervical or lumbar spine. Surgical approaches have higher morbidities than lumbar pathologies because of the presence of the cord itself; and higher than that of cervical spine because of the chest cavity. Reasonable approaches include a transthoracic approach with fusion and instrumentation, a postero-lateral transpedicular approach, and lateral costotransversectomy approach. Laminectomy alone would NOT be adequate. GULFCOASTBRAINANDSPINE.COM--Peter Yeh, 2005-11-18
Additional Details:

Case Number: 3205826Last Updated: 06-30-2006
Anatomy: Spine and Peripheral Nervous System   Pathology: Trauma
Modality: Conventional Radiograph, MRExam Date: Access Level: Readable by all users
Keywords: intervertebral disc calcification; herniated disc; herniated nucleus pulposis

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