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Worsening Leg Weakness With A Mediastinal Mass


Consult Page

4mo boy p/w BLE weakness and large mediastinal mass

Initial Imaging

Fig. 50.1, Spine MRI with and without contrast. A. Right-sided sagittal T2-weighted sequence demonstrates a large 7 x 5 x 5 cm intrathoracic mass. Of note, the patient’s bladder is distended. B. Midline sagittal T2-weighted sequence demonstrates multilevel epidural extension of the mass, resulting in severe canal stenosis with cord compression. C. Axial T1-weighted sequence with contrast at T2-3 demonstrates intraspinal extension of the tumor through the right T2 foramen (asterisk), causing severe leftward displacement and compression of the spinal cord (arrow).

Walking Thoughts

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    What is the patient’s neurological exam? How weak is the patient? Does he have any other symptoms of sensation, bowel, or bladder dysfunction?

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    What is the timeline of his deficits?

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    What is his prior medical history including any congenital or developmental problems?

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    Does he have any other lesions elsewhere?

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