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Journal of Radiology Case Reports

Extraspinal findings on lumbar spine MR imaging

Review Article

Nathalie V. Gebara1, Daniel E. Meltzer1*

Radiology Case. 2009 Aug; 3(8):5-13 :: DOI: 10.3941/jrcr.v3i8.213

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1. Department of Radiology, St. Lukes-Roosevelt Hospital Center, New York, NY, USA

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  ABSTRACT
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Abstract
Introduction
Discussion
Teaching Point
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Interpretation of radiologic studies requires vigilance on the part of the radiologist to identify findings and abnormalities outside the region of interest. In the case of routine lumbar spine MRI for low back pain, many extraspinal abnormalities can often be identified. Some of these findings may account for low back pain. Other findings are incidental, but may have significant clinical implications, and are important to recognize. We present twenty-four examples of incidental findings from lumbar spine MRI examinations. The findings involve various organ systems, covering a broad range of clinical urgency.



  INTRODUCTION
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Abstract
Introduction
Discussion
Teaching Point
Figures
References
Abbreviations
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Lumbar spine MR images were selected from examinations on twenty-three patients (one of which provides two extraspinal findings for discussion) ranging in age from 40 to 75 years of age. All of the examinations were done for the chief complaint of low back pain, with the majority of the prescriptions expressing the expectation of disk herniation or other manifestations of lumbar degenerative disease. All of the examinations followed a standard protocol for MR imaging of the lumbar spine, utilizing a 1.5 Tesla GE magnet with axial and sagittal T1 and T2 weighted sequences. Intravenous gadolinium was administered in some cases, for example if there was a history of recent surgery.

In this collection, there are examples of extraspinal abnormalities from various organ systems. These are addressed in several groups below.


Vascular:
Vascular extraspinal abnormalities include aortic dissection, aortic aneurysm and lymphatic anomalies. An aortic dissection would present as a hypointense linear filling defect traversing the lumen of the aorta, which represents the intimal flap (Fig. 1 Preview this figure

Figure 1: Magnetic Resonance Imaging
57 year old man. Axial T2 weighted image through the infrarenal aorta demonstrates an intimal flap consistent with aortic dissection.
). Abnormal dilatation of the infrarenal aorta is consistent with aneurysm (Fig. 2 Preview this figure
Figure 2: Magnetic Resonance Imaging
87 year old man. Axial T2 weighted image through the infrarenal aorta demonstrates an approximately 4cm infrarenal aortic aneurysm.
). Prominent lymphatic vessels may present as T2 hyperintense tubular structures in the retroperitoneal space, following the course of the iliac veins (Fig. 3 Preview this figure
Figure 3: Magnetic Resonance Imaging
43 year old woman. Axial T2 weighted image at the level of the inferior renal poles demonstrates tubular hyperintense structures in the retroperitoneum consistent with incidental prominent lymphatics.
). Retroperitoneal lymphadenopathy may appear as multiple rounded intermediate signal lesions, or more confluent abnormal soft tissue, depending on the underlying pathology (Fig. 4 Preview this figure
Figure 4: Magnetic Resonance Imaging
Different appearances of retroperitoneal lymphadenopathy. In the left panel, a 59 year old man with bladder carcinoma. Axial T1 image at the level of the renal arteries shows aortocaval adenopathy with a confluent appearance. Lymphoma or retroperitoneal fibrosis may have a similar appearance. In the right panel, a 77 year old man with prostate carcinoma. Axial T2 weighted image at the level of the renal midpole shows discrete retroperitoneal masses consistent with aortocaval adenopathy.
).

The findings of aortic aneurysm and dissection have potentially serious clinical implications. In contradistinction, it is important to recognize prominent lymphatics as a physiologic variant. Lymphadenopathy may be an unexpected finding, depending on the clinical scenario, and may alter staging and/or treatment options in patients with cancer.


Genitourinary:
Genitourinary extraspinal findings include adrenal masses, renal masses, renal infarct, hydronephrosis, renal cysts, developmental renal anomalies, and bladder anomalies. Various uterine findings may be present, such as leiomyomas, adenomyosis, and gravid or postpartum uterus.

Adrenal masses may be often confirmed as adenomas by correlating with CT (Fig. 5 Preview this figure
Figure 5: Magnetic Resonance Imaging
60 year old man. Two sequential axial T2 weighted MR images demonstrate bilateral hypointense adrenal lesions. A separate non-contrast CT axial image (inset) demonstrates low density adrenal lesions. In this case the adrenal masses measured less than 10 Hounsfield units in density (measurement not shown), which confirms adrenal adenomas.
). Renal cell carcinoma may present as a complex mass of variable size and signal characteristics (Fig. 6 Preview this figure
Figure 6: Magnetic Resonance Imaging
57 year old man. Axial T2 weighted image at renal midpole level demonstrates a large heterogeneous right renal mass later proven to be a renal cell carcinoma.
).

Patients with a history of prior discectomy may receive intravenous contrast for their lumbar MR examination (to help differentiate recurrent disc herniation from postoperative granulation tissue), which allows detection of some findings which would be occult with noncontrast technique. For example, renal infarct typically presents as a wedge-shaped region of absent enhancement, with capsular sparing (Fig. 7 Preview this figure
Figure 7: Magnetic Resonance Imaging
66 year old man. Axial post contrast fat suppressed T1 weighted image at level of renal hila demonstrates a wedge shaped region of absent enhancement in the right renal parenchyma with a rim of capsular sparing, consistent with a renal infarct.
).

Abnormal dilatation of the renal collecting system, representing hydronephrosis, may be included in the field of view, most often on the axial images (Fig. 8 Preview this figure
Figure 8: Magnetic Resonance Imaging
72 year old woman. Axial T2 weighted image from an open magnet study demonstrates dilatation of the right renal collecting system, consistent with unilateral hydronephrosis.
), although the cause of the hydronephrosis may not visible on the lumbar MRI study. Early detection of hydronephrosis may enable the clinician to identify and treat the underlying cause prior to permanent loss of kidney function.

Adult polycystic kidney disease ultimately manifests as innumerable bilateral renal cysts, which may even replace any visible normal parenchyma. The cysts may contain debris levels from prior hemorrhage, and, in some cases, a transplanted kidney may be visible in the pelvis on more caudal images (Fig. 9 Preview this figure
Figure 9: Magnetic Resonance Imaging
47 year old man. Axial T2 weighted image at renal midpole level demonstrates bilateral hyperintense T2 lesions replacing the kidneys in a patient with autosomal dominant polycystic kidney disease (note multiple hematocrit levels). More caudally, a transplanted kidney is seen in the right pelvis (arrow).
). Various developmental renal anomalies may be visible on lumbar MRI, such as horseshoe kidney (Fig. 10 Preview this figure
Figure 10: Magnetic Resonance Imaging
33 year old woman. Axial T2 weighted image at the level of the inferior renal poles demonstrates fusion of the kidneys at the midline, consistent with a horseshoe kidney.
). Horseshoe kidneys have higher incidence of stone formation than normal kidneys, and put the patient at higher risk for traumatic injury to the kidneys.

A ureterocele will present as a round cystic mass in the bladder, at the expected location of the ureteral orifice (Fig. 11 Preview this figure
Figure 11: Magnetic Resonance Imaging
26 year old woman. Sagittal T2 weighted image demonstrates a thin walled cystic mass within the inferolateral aspect of the urinary bladder, consistent with a ureterocele.
). Ureterocele may be associated with ureteral obstruction.

Incidental uterine findings are also commonly seen on routine lumbar imaging. One of the most common is a uterine leiomyoma (fibroid), which will typically present as a mural, subserosal or submucosal mass (Fig. 12 Preview this figure
Figure 12: Magnetic Resonance Imaging
44 year old woman. Sagittal T2 weighted image demonstrates multiple hypointense uterine masses consistent with mural and subserosal leiomyomas.
). Adenomyosis appears as thickening of the uterine junctional zone (Fig. 13 Preview this figure
Figure 13: Magnetic Resonance Imaging
37 year old woman. Sagittal T2 weighted demonstrates widening of the hypointense uterine junctional zone, consistent with adenomyosis.
.

A postpartum uterus will typically be enlarged, with heterogeneous signal and varying amounts of intrauterine fluid (Fig. 14 Preview this figure
Figure 14: Magnetic Resonance Imaging
21 year old woman. Sagittal T2 weighted image demonstrates an enlarged uterus with areas of myometrial signal hyperintensity, in a postpartum patient.
). A gravid uterus may present with various partly visualized fetal parts (Fig. 15 Preview this figure
Figure 15: Magnetic Resonance Imaging
22 year old woman. Sagittal T2 weighted image demonstrates a partially imaged gravid uterus with a visible fetal brain.
). Obviously, the patient and referring physician will be aware of the postpartum status, and it is important for the radiologist to recognize this appearance in order to avoid misdiagnosis. However, the presence of a fetus may require explicit communication, especially if additional imaging or intravenous contrast is needed.


Gastrointestinal:
Gastrointestinal extraspinal findings may include various pathology of the liver, biliary system, gallbladder, intestines or spleen. Colon cancer will often appear as an area of focal or segmental mural thickening (Fig. 16 Preview this figure
Figure 16: Magnetic Resonance Imaging
80 year old woman. Axial T2 weighted image at the L5 level detects concentric colonic wall thickening in the right lower quadrant, later confirmed to be carcinoma.
). Cholelithiasis will typically manifest as multiple layering hypointense structures in the gallbladder (Fig. 17 Preview this figure
Figure 17: Magnetic Resonance Imaging
44 year old woman. Axial T2 weighted image at the level of the pancreas demonstrates multiple hypointense structures layering dependently within the gallbladder, consistent with gallstones.
). Prominence of common bile duct may be visible at the level of the pancreatic head (Fig. 18 Preview this figure
Figure 18: Magnetic Resonance Imaging
49 year old woman. Axial T2 weighted image at renal midpole level demonstrates a hyperintense structure in the region of the pancreatic head, consistent with a prominent distal common bile duct.
). These findings illustrate the varying degrees of clinical urgency which may be associated with incidental findings on lumbar MRI. Again, it is also important to recognize normal variants such an accessory splenule (Fig. 19 Preview this figure
Figure 19: Magnetic Resonance Imaging
52 year old man. Axial T2 weighted image at the level of the superior renal poles demonstrates a lesion slightly higher than muscle intensity in the left upper quadrant, consistent with an accessory splenule.
), and the multiple tiny cystic structures seen in the liver in Fig. 20 Preview this figure
Figure 20: Magnetic Resonance Imaging
67 year old man. Axial T2 weighted image at the level of the superior renal poles demonstrates multiple small cystic lesions in the liver, consistent with biliary hamartomas (von Meyenberg complex).
, consistent with benign biliary hamartomas (von Meyenberg complex).


Musculoskeletal:
Extraspinal findings in the musculoskeletal system may include abnormalities of the paraspinal musculature or the bony pelvis. Retroperitoneal hematoma may present as a complex heterogeneous intensity mass (Fig. 21 Preview this figure
Figure 21: Magnetic Resonance Imaging
77 year old man, same patient as in the right panel of figure 4. Axial T1 weighted image at the level of S1 shows abnormal areas of signal hypointensity in the sacrum and iliac crests, consistent with metastatic disease in this patient with prostate carcinoma.
). The presence of blood products, rapid onset of symptoms, and pertinent history (e.g. anticoagulation) may help to make the diagnosis. Skeletal metastases (Fig. 22 Preview this figure
Figure 22: Magnetic Resonance Imaging
68 year old man. Axial and sagittal T2 weighted images (left and center panel) demonstrate a large heterogeneous mass in the left psoas region with complex internal septations, consistent with a retroperitoneal hematoma. Corresponding axial CT image (right panel) at this level shows additional finding of a small hematocrit level.
) may or may not be an expected finding, depending on the clinical scenario. Similar to lymphadenopathy, staging and treatment options for oncology patients may be affected by this finding. Various benign bone lesions may present a diagnostic dilemma, and the associated clinical history is key. For example, brown tumors (Fig. 23 Preview this figure
Figure 23: Magnetic Resonance Imaging
38 year old man. Axial T1 weighted image at the level of the iliac crests shows bilateral well defined expansile iliac masses, consistent with Brown tumors in a man with chronic renal disease.
) are more easily diagnosed once one is aware of the patient`s underlying renal disease.


Situs Inversus:
This entity (Fig. 24 Preview this figure
Figure 24: Magnetic Resonance Imaging
73 year old woman. Axial T2 weighted image at the level of the diaphragm shows stomach and spleen on the right, liver and inferior vena cava on the left, consistent with situs inversus.
) is a fitting reminder that all organs in the field of view may potentially be a source of incidental findings, including abnormal location. Careful scrutiny of the scanning technique is necessary to exclude errors of annotation due to unorthodox patient positioning.

  DISCUSSION
Top
Abstract
Introduction
Discussion
Teaching Point
Figures
References
Abbreviations
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As with all radiologic studies, images obtained for evaluation of the lumbar spine commonly include many organ systems outside the region of interest. The structures most commonly included are portions of the genitourinary and gastrointestinal systems. Incidental vascular and musculoskeletal findings are also common. Although many of the findings are incidental, many are often the cause of the chief complaint, namely low back pain. Some of the incidental findings represent potentially life threatening conditions which are asymptomatic. In some cases, the radiologist may be interpreting the images while the patient is still in the scanner. In such circumstances, detection of extraspinal pathology may prompt acquisition of additional sequences or imaging planes, or additional advanced techniques such as fat suppression. Adjusting the saturation block may allow improved visualization of the finding in question.

A study by Konnak et al (1) described an increased survival rate in patients with renal cell carcinoma that was incidentally detected, compared to tumors presenting with symptoms. The authors speculated that the detection of the lesions prior to development of symptoms was likely related to lower tumor stage at the time of diagnosis.
In a later retrospective study by Frager et al (2), of 1517 lumbar CT examinations, extraspinal pathology was demonstrated in 22 (1.45%) including retroperitoneal tumors and lymphadenopathy as well as vascular, urinary tract and gynecologic abnormalities. Although infrequent, some of the findings had serious clinical implications. In a more recent study, Wagner et al (3) described a large increase in the number of incidental findings described on lumbar MRI since the widespread use of picture archiving communications systems. Similar findings were described by Green (4). As would be expected, the lumbar spine is not the only anatomic region in which incidental findings have been increasingly detected with the advent of progressively advanced imaging techniques. A similar trend has also been described in brain imaging, for example, in an article by Vernooij et al (5).

In considering the impact of incidental findings on patient care, it is also important to remember the implications for the field of radiology. Currently, practitioners from many subspecialties are involved in the interpretation of radiologic studies, including cardiologists, vascular surgeons, and neurologists and neurosurgeons. Many of these specialists are skilled in interpreting their organ system of interest. However, the general training received by radiologists arguably makes them the best equipped to detect incidental findings. This article emphasizes the importance of making the incidental finding in the lumbar spine MRI, but the concept is universal to all imaging studies in radiology.

  TEACHING POINT
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Abstract
Introduction
Discussion
Teaching Point
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References
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Lumbar MRI obtained for low back pain may reveal findings within any of the organ systems included in the field of view. Vigilance on the part of the radiologist may aid in diagnosis of extraspinal causes of pain. Of equal importance is the detection of asymptomatic but clinically significant conditions.








  FIGURES
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Abstract
Introduction
Discussion
Teaching Point
Figures
References
Abbreviations
More Images

Display figure 1 in original size

Figure 1: 57 year old man. Axial T2 weighted image through the infrarenal aorta demonstrates an intimal flap consistent with aortic dissection.

Figure 1: Magnetic Resonance Imaging (Open in original size)
57 year old man. Axial T2 weighted image through the infrarenal aorta demonstrates an intimal flap consistent with aortic dissection.

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Display figure 2 in original size
Figure 2: 87 year old man. Axial T2 weighted image through the infrarenal aorta demonstrates an approximately 4cm infrarenal aortic aneurysm.

Figure 2: Magnetic Resonance Imaging (Open in original size)
87 year old man. Axial T2 weighted image through the infrarenal aorta demonstrates an approximately 4cm infrarenal aortic aneurysm.

Back Back


Display figure 3 in original size
Figure 3: 43 year old woman. Axial T2 weighted image at the level of the inferior renal poles demonstrates tubular hyperintense structures in the retroperitoneum consistent with incidental prominent lymphatics.

Figure 3: Magnetic Resonance Imaging (Open in original size)
43 year old woman. Axial T2 weighted image at the level of the inferior renal poles demonstrates tubular hyperintense structures in the retroperitoneum consistent with incidental prominent lymphatics.

Back Back


Display figure 4 in original size
Figure 4: Different appearances of retroperitoneal lymphadenopathy. In the left panel, a 59 year old man with bladder carcinoma. Axial T1 image at the level of the renal arteries shows aortocaval adenopathy with a confluent appearance. Lymphoma or retroperitoneal fibrosis may have a similar appearance. In the right panel, a 77 year old man with prostate carcinoma. Axial T2 weighted image at the level of the renal midpole shows discrete retroperitoneal masses consistent with aortocaval adenopathy.

Figure 4: Magnetic Resonance Imaging (Open in original size)
Different appearances of retroperitoneal lymphadenopathy. In the left panel, a 59 year old man with bladder carcinoma. Axial T1 image at the level of the renal arteries shows aortocaval adenopathy with a confluent appearance. Lymphoma or retroperitoneal fibrosis may have a similar appearance. In the right panel, a 77 year old man with prostate carcinoma. Axial T2 weighted image at the level of the renal midpole shows discrete retroperitoneal masses consistent with aortocaval adenopathy.

Back Back


Display figure 5 in original size
Figure 5: 60 year old man. Two sequential axial T2 weighted MR images demonstrate bilateral hypointense adrenal lesions. A separate non-contrast CT axial image (inset) demonstrates low density adrenal lesions. In this case the adrenal masses measured less than 10 Hounsfield units in density (measurement not shown), which confirms adrenal adenomas.

Figure 5: Magnetic Resonance Imaging (Open in original size)
60 year old man. Two sequential axial T2 weighted MR images demonstrate bilateral hypointense adrenal lesions. A separate non-contrast CT axial image (inset) demonstrates low density adrenal lesions. In this case the adrenal masses measured less than 10 Hounsfield units in density (measurement not shown), which confirms adrenal adenomas.

Back Back


Display figure 6 in original size
Figure 6: 57 year old man. Axial T2 weighted image at renal midpole level demonstrates a large heterogeneous right renal mass later proven to be a renal cell carcinoma.

Figure 6: Magnetic Resonance Imaging (Open in original size)
57 year old man. Axial T2 weighted image at renal midpole level demonstrates a large heterogeneous right renal mass later proven to be a renal cell carcinoma.

Back Back


Display figure 7 in original size
Figure 7: 66 year old man. Axial post contrast fat suppressed T1 weighted image at level of renal hila demonstrates a wedge shaped region of absent enhancement in the right renal parenchyma with a rim of capsular sparing, consistent with a renal infarct.

Figure 7: Magnetic Resonance Imaging (Open in original size)
66 year old man. Axial post contrast fat suppressed T1 weighted image at level of renal hila demonstrates a wedge shaped region of absent enhancement in the right renal parenchyma with a rim of capsular sparing, consistent with a renal infarct.

Back Back


Display figure 8 in original size
Figure 8: 72 year old woman. Axial T2 weighted image from an open magnet study demonstrates dilatation of the right renal collecting system, consistent with unilateral hydronephrosis.

Figure 8: Magnetic Resonance Imaging (Open in original size)
72 year old woman. Axial T2 weighted image from an open magnet study demonstrates dilatation of the right renal collecting system, consistent with unilateral hydronephrosis.

Back Back


Display figure 9 in original size
Figure 9: 47 year old man. Axial T2 weighted image at renal midpole level demonstrates bilateral hyperintense T2 lesions replacing the kidneys in a patient with autosomal dominant polycystic kidney disease (note multiple hematocrit levels). More caudally, a transplanted kidney is seen in the right pelvis (arrow).

Figure 9: Magnetic Resonance Imaging (Open in original size)
47 year old man. Axial T2 weighted image at renal midpole level demonstrates bilateral hyperintense T2 lesions replacing the kidneys in a patient with autosomal dominant polycystic kidney disease (note multiple hematocrit levels). More caudally, a transplanted kidney is seen in the right pelvis (arrow).

Back Back


Display figure 10 in original size
Figure 10: 33 year old woman. Axial T2 weighted image at the level of the inferior renal poles demonstrates fusion of the kidneys at the midline, consistent with a horseshoe kidney.

Figure 10: Magnetic Resonance Imaging (Open in original size)
33 year old woman. Axial T2 weighted image at the level of the inferior renal poles demonstrates fusion of the kidneys at the midline, consistent with a horseshoe kidney.

Back Back


Display figure 11 in original size
Figure 11: 26 year old woman. Sagittal T2 weighted image demonstrates a thin walled cystic mass within the inferolateral aspect of the urinary bladder, consistent with a ureterocele.

Figure 11: Magnetic Resonance Imaging (Open in original size)
26 year old woman. Sagittal T2 weighted image demonstrates a thin walled cystic mass within the inferolateral aspect of the urinary bladder, consistent with a ureterocele.

Back Back


Display figure 12 in original size
Figure 12: 44 year old woman. Sagittal T2 weighted image demonstrates multiple hypointense uterine masses consistent with mural and subserosal leiomyomas.

Figure 12: Magnetic Resonance Imaging (Open in original size)
44 year old woman. Sagittal T2 weighted image demonstrates multiple hypointense uterine masses consistent with mural and subserosal leiomyomas.

Back Back


Display figure 13 in original size
Figure 13: 37 year old woman. Sagittal T2 weighted demonstrates widening of the hypointense uterine junctional zone, consistent with adenomyosis.

Figure 13: Magnetic Resonance Imaging (Open in original size)
37 year old woman. Sagittal T2 weighted demonstrates widening of the hypointense uterine junctional zone, consistent with adenomyosis.

Back Back


Display figure 14 in original size
Figure 14: 21 year old woman. Sagittal T2 weighted image demonstrates an enlarged uterus with areas of myometrial signal hyperintensity, in a postpartum patient.

Figure 14: Magnetic Resonance Imaging (Open in original size)
21 year old woman. Sagittal T2 weighted image demonstrates an enlarged uterus with areas of myometrial signal hyperintensity, in a postpartum patient.

Back Back


Display figure 15 in original size
Figure 15: 22 year old woman. Sagittal T2 weighted image demonstrates a partially imaged gravid uterus with a visible fetal brain.

Figure 15: Magnetic Resonance Imaging (Open in original size)
22 year old woman. Sagittal T2 weighted image demonstrates a partially imaged gravid uterus with a visible fetal brain.

Back Back


Display figure 16 in original size
Figure 16: 80 year old woman. Axial T2 weighted image at the L5 level detects concentric colonic wall thickening in the right lower quadrant, later confirmed to be carcinoma.

Figure 16: Magnetic Resonance Imaging (Open in original size)
80 year old woman. Axial T2 weighted image at the L5 level detects concentric colonic wall thickening in the right lower quadrant, later confirmed to be carcinoma.

Back Back


Display figure 17 in original size
Figure 17: 44 year old woman. Axial T2 weighted image at the level of the pancreas demonstrates multiple hypointense structures layering dependently within the gallbladder, consistent with gallstones.

Figure 17: Magnetic Resonance Imaging (Open in original size)
44 year old woman. Axial T2 weighted image at the level of the pancreas demonstrates multiple hypointense structures layering dependently within the gallbladder, consistent with gallstones.

Back Back


Display figure 18 in original size
Figure 18: 49 year old woman. Axial T2 weighted image at renal midpole level demonstrates a hyperintense structure in the region of the pancreatic head, consistent with a prominent distal common bile duct.

Figure 18: Magnetic Resonance Imaging (Open in original size)
49 year old woman. Axial T2 weighted image at renal midpole level demonstrates a hyperintense structure in the region of the pancreatic head, consistent with a prominent distal common bile duct.

Back Back


Display figure 19 in original size
Figure 19: 52 year old man. Axial T2 weighted image at the level of the superior renal poles demonstrates a lesion slightly higher than muscle intensity in the left upper quadrant, consistent with an accessory splenule.

Figure 19: Magnetic Resonance Imaging (Open in original size)
52 year old man. Axial T2 weighted image at the level of the superior renal poles demonstrates a lesion slightly higher than muscle intensity in the left upper quadrant, consistent with an accessory splenule.

Back Back


Display figure 20 in original size
Figure 20: 67 year old man. Axial T2 weighted image at the level of the superior renal poles demonstrates multiple small cystic lesions in the liver, consistent with biliary hamartomas (von Meyenberg complex).

Figure 20: Magnetic Resonance Imaging (Open in original size)
67 year old man. Axial T2 weighted image at the level of the superior renal poles demonstrates multiple small cystic lesions in the liver, consistent with biliary hamartomas (von Meyenberg complex).

Back Back


Display figure 21 in original size
Figure 21: 77 year old man, same patient as in the right panel of figure 4. Axial T1 weighted image at the level of S1 shows abnormal areas of signal hypointensity in the sacrum and iliac crests, consistent with metastatic disease in this patient with prostate carcinoma.

Figure 21: Magnetic Resonance Imaging (Open in original size)
77 year old man, same patient as in the right panel of figure 4. Axial T1 weighted image at the level of S1 shows abnormal areas of signal hypointensity in the sacrum and iliac crests, consistent with metastatic disease in this patient with prostate carcinoma.

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Display figure 22 in original size
Figure 22: 68 year old man. Axial and sagittal T2 weighted images (left and center panel) demonstrate a large heterogeneous mass in the left psoas region with complex internal septations, consistent with a retroperitoneal hematoma. Corresponding axial CT image (right panel) at this level shows additional finding of a small hematocrit level.

Figure 22: Magnetic Resonance Imaging (Open in original size)
68 year old man. Axial and sagittal T2 weighted images (left and center panel) demonstrate a large heterogeneous mass in the left psoas region with complex internal septations, consistent with a retroperitoneal hematoma. Corresponding axial CT image (right panel) at this level shows additional finding of a small hematocrit level.

Back Back


Display figure 23 in original size
Figure 23: 38 year old man. Axial T1 weighted image at the level of the iliac crests shows bilateral well defined expansile iliac masses, consistent with Brown tumors in a man with chronic renal disease.

Figure 23: Magnetic Resonance Imaging (Open in original size)
38 year old man. Axial T1 weighted image at the level of the iliac crests shows bilateral well defined expansile iliac masses, consistent with Brown tumors in a man with chronic renal disease.

Back Back


Display figure 24 in original size
Figure 24: 73 year old woman. Axial T2 weighted image at the level of the diaphragm shows stomach and spleen on the right, liver and inferior vena cava on the left, consistent with situs inversus.

Figure 24: Magnetic Resonance Imaging (Open in original size)
73 year old woman. Axial T2 weighted image at the level of the diaphragm shows stomach and spleen on the right, liver and inferior vena cava on the left, consistent with situs inversus.

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  REFERENCES
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Abstract
Introduction
Discussion
Teaching Point
Figures
References
Abbreviations
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1. Konnak JW, Grossman HB. Renal cell carcinoma as an incidental finding. Journal of Urology 1985; 134(6):1094-6. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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2. Frager DH, Elkin CM, Kansler F, Mendelsohn SL, Leeds NE. Extraspinal abnormalities identified on lumbar spine CT. Neuroradiology 1986; 28 (1): 58-60. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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3. Wagner SC, Morrison WB, Carrino JA, Schweltzer ME, Nothnagel H. Picture Archiving and Communication System: Effect on Reporting of Incidental Findings. Radiology 2002; 225: 500-505. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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4. Green L. PACS: effect on incidental findings. Radiology Management 2004; 26(1):26-29. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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5. Vernooij MW. Incidental findings on brain MRI in the general population. N Engl J Med 2007; 357: 1821-8. Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine

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  ABBREVIATIONS
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CT = Computed Tomography
MRI = Magnetic Resonance Imaging








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