Lung cancer underlying paravertebral abscess with intramedullary spinal cord metastases.

To cite: Iliescu L, Toma L. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-201070 DESCRIPTION A 59-year-old patient presented with a 2-month history of increasing backache irradiating in the abdomen. All standard laboratory tests results were within the normal limits, with the exception of a moderate inflammatory syndrome. Lower limb paralysis occurred soon after admission. A neurological examination revealed a complete loss of motor function. An MRI displayed the pathological compressive fractures of the T1, T6, T11, T12 vertebral bodies and the total damage of the T7–T8 vertebrae, with total destruction of the T7 vertebral body and vertebrae compaction (figure 1). The MRI also displayed a large expansive soft tissue mass, located at the costovertebral joints T7– T8 (figure 2). The CT scan displayed a large necrotic mass on the right side, which completely penetrated the bone cortex and invaded the T7–T8 vertebral bodies; it highlighted a massive pleural effusion on the left side (figure 3). The patient died within 2h after the examination. Despite the fact that the patient showed relatively common symptoms, his condition deteriorated rapidly after admission. Initially the lower limb paralysis required performing an MRI exam, the suspected diagnosis being the pathological compressive fracture. The large soft tissue mass expanding from the lung motivated us to perform a CT scan. It is essential to be aware of the different manifestations of spinal metastatic disease, as the spine is the most common site of osseous metastatic disease. 2