Keywords:
Multicentre study, Case-control study, Retrospective, Tissue characterisation, Diagnostic procedure, MR, Neuroradiology peripheral nerve, Genital / Reproductive system female, Genitourinary
Authors:
A. Francavilla1, P. milillo2, A. N. Cintoli2, C. Bristogiannis2, L. P. Stoppino2, R. Vinci2, L. Macarini2; 1Foggia /IT, 2Foggia/IT
DOI:
10.26044/ecr2020/C-12311
Results
Case 1
A 45-year-old woman underwent a lumbar spine MRI in our Diagnostic Imaging Department because of a progressive worsening of low back pain, sciatica-like, extended to the left lower limb.
The previous MRI examination, performed five years before, revealed the presence of disc protrusions at L3-L4 and L5-S1, without significant radiologic signs of radicular impingement. A Tarlov cyst of about 5.5x2.5cm was supposed at S2. Besides, some collateral findings were demonstrated: a retroverse uterus surrounded by little myomatus-like signal anomalies, a big cyst-like lesion stuck to the fundus well-defined, with regular margins and a maximum diameter of about 2.5cm (Fig.1).
According to the clinical presentation it was thought to be related to an endometrioma with nerve compression and not to Tarlov cyst or disc pathology.
Case 2
A 25-year-old woman presented a two-months history of constant pain in her left thigh, without trauma and with insidious onset. A diagnosis of soft-tissue injury was made. Despite anti-inflammatory medication and physiotherapy, a sciatica-like pain increased and radiated to the back and down to the postero-lateral side of leg and foot, becoming very severe during menstruation.
Two years later she developed lameness and needed crutches: the pain, exacerbated by hip flexion and knee extension, was evaluated by means of Visual Analogue Scale (VAS, score 7) and Peripheral Nerve Injury scale (PNI, score 2).
There were no apparent muscle wasting or sympathetic changes in leg and foot: reflexes and motor function were partially preserved (straight-leg raising was about 30°), sciatic region palpation was painful and there was a little weakness in femur biceps.
Sciatic endometriosis was supposed. The MRI examination of the lumbar spine and hip demonstrated a mixed-signal arising from the left sciatic nerve notch, which seemed to be entrapped by an undefined pseudo-nodular formation whose signal was compatible with pelvic endometriosis (Fig. 3). The following histopathological examination confirmed sciatic nerve endometriosis without malignancy.