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Giant Cystic Schmorl's Nodes

Imaging Findings in Six Patients

Olivier Hauger1, Anne Cotten2, Jean-François Chateil1, Olivier Borg3, Maryse Moinard1 and François Diard1

1 Service de Radiologie A, Groupe Hospitalier Pellegrin, CHRU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux Cedex, France.
2 Service de Radiologie, Hôpital B, CHRU Lille, Blvd. de Pr. J. Leclerc, 59037 Lille Cedex, France.
3 Service de Radiologie, Hôpital Jean Bernard, CHRU Poiters, BP 577, 86021 Poiters Cedex, France.



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  		Fig. 1. —17-year-old girl with 2-year history of lower back pain. No history of specific trauma except fall on her back during childhood. Radiograph shows well-damarcated, sharply circumscribed lytic lesion of vertebral body of L3 in contact with superior intervertebral space (arrow).

 


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  		Fig. 2A. —19-year-old woman, a basketball player, with 2-year history of lower back pain and evidence of Scheuermann's disease sequelae. Axial CT scan shows well-delineated osteolytic lesion of vertebral body of L3 surrounded by sclerotic rim.

 


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  		Fig. 2B. —19-year-old woman, a basketball player, with 2-year history of lower back pain and evidence of Scheuermann's disease sequelae. Sagittal two-dimensional reconstruction of CT scan reveals contact of lesion with interrupted superior surface of vertebral body.

 


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  		Fig. 3A. —24-year-old woman with 6-month history of lower back pain and evidence of lytic lesion of vertebral body of L4. Diskograph shows leakage of contrast material from disk into lesion, confirming hypothesis of Schmorl's node. Note fluid—fluid level (arrow). Patient is in lateral position.

 


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  		Fig. 3B. —24-year-old woman with 6-month history of lower back pain and evidence of lytic lesion of vertebral body of L4. Axial CT scan after diskography shows presence of contrast material in lesion with fluid—fluid level (arrow). Presence of air (arrowhead) on top of lesion is attributable to procedure.

 


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  		Fig. 3C. —24-year-old woman with 6-month history of lower back pain and evidence of lytic lesion of vertebral body of L4. Sagittal two-dimensional reconstruction of CT scan after diskography more clearly reveals leakage of contrast material from disk into lesion. Again, fluid—fluid level (arrowheads) confirms cystic nature of lesion.

 


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  		Fig. 4A. —Lumbar spine images of 20-year-old woman hospitalized for febrile meningeal syndrome. Incidental finding of typical giant cystic Schmorl's node occupying total height of L4 vertebral body. Sagittal two-dimensional reconstruction of CT scan reveals interruption of superior surface of vertebral body.

 


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  		Fig. 4B. —Lumbar spine images of 20-year-old woman hospitalized for febrile meningeal syndrome. Incidental finding of typical giant cystic Schmorl's node occupying total height of L4 vertebral body. On sagittal T1-weighted MR image (TR/TE, 550/20), lesion appears as low signal intensity.

 


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  		Fig. 4C. —Lumbar spine images of 20-year-old woman hospitalized for febrile meningeal syndrome. Incidental finding of typical giant cystic Schmorl's node occupying total height of L4 vertebral body. On sagittal T2-weighted image (3500/110), center of lesion appears lobulated and has high signal intensity. Lesion has lower intensity wall. Note degenerative pattern of adjacent intervertebral disks.

 


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  		Fig. 4D. —Lumbar spine images of 20-year-old woman hospitalized for febrile meningeal syndrome. Incidental finding of typical giant cystic Schmorl's node occupying total height of L4 vertebral body. Axial fat-suppressed T1-weighted MR image (605/15) after gadolinium injection shows thin peripheral enhancement likely to be related to presence of granulation tissue. Note epidural enhancement next to iterative lumbar punctures (arrow).

 


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  		Fig. 5A. —Lumbar spine of 21-year-old woman with lower back pain. Sagittal T2-weighted MR image (TR/TE, 3000/90) shows cystic Schmorl's node occupying two thirds of third vertebral body height. Again, there is high signal centrally and surrounding wall of lower signal intensity. Note contact of lesion with superior vertebral surface and degenerative pattern of superior intervertebral disk.

 


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  		Fig. 5B. —Lumbar spine of 21-year-old woman with lower back pain. Sagittal T2-weighted MR image (2800/120) obtained 2 years after A does not show any change in appearance of lesion except that surrounding wall appears slightly thinner. At time of examination, patient no longer complained of lower back pain.

 

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