Disseminated spinal lymphangiomatosis.

Dear Sir,

A 17-year-old patient presented complaining of low back pain of 2 years duration which aggravated in the past 6 months. This was accompanied by bilateral pins and needles sensations over his lower extremities as well as worsening shortness of breath. Spinal magnetic resonance imaging (MRI) showed extensive hyperintense lesions of all lumbar vertebral bodies, bilateral sacrum and iliac as well as prevertebral areas and the retroperitoneum [Figure 1]. The lesions were hyperintense on both T1- [Figure 2a] and T2-weighted [Figure 2b] images. On the chest computed tomography (CT) scan, diffuse right-sided chylothorax associated with mediastinal shift was detected [Figure 3]. Histopathological examination of the vertebral bodies and iliac crest biopsy samples revealed extensive lymphangiomatosis. This is a congenital benign condition of the lymphatic system proliferation which can affect osseous and visceral organs and usually diagnosed before age of 20 years.[1] It has been advocated that MRI should be obtained in the assessment of this condition owing to its superiority to CT scan.[2] In this patient, a pleuroperitoneal shunt was inserted. On the last follow-up, he was in good general condition with no complaint.

Figure 1

(a) Sagittal T2-weighted spinal magnetic resonance imaging shows hyperintense lesions of the lumbar vertebral body and spinous processes. (b) Sagittal T1-weighted magnetic resonance imaging of the lumbar spine shows mixed hyper- and hypo-intense lesions of the vertebral bodies and spinous processes. (c) Coronal T2-weighted magnetic resonance imaging of the lumbar spine shows hyperintense lesions of the vertebral bodies

Figure 2

(a) Axial T1-weighted magnetic resonance imaging of the lumbar spine shows hyperintense lesions of the vertebral body and paravertebral tissues and retroperitoneum. (b) Axial T2-weighted magnetic resonance imaging of the lumbar spine shows hyperintense lesion of the vertebral body

Figure 3

Axial computed tomography scan of the chest shows massive right chylothorax with mediastinal shift

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