Tunneling Schmorl's nodes in an elderly woman treated for acute lymphoblastic leukemia

Acute Schmorl's Node during Strenuous Monofin Swimming: A Case Report and Review of the Literature

Study Design This case report describes an acute Schmorl's node (SN) in an elite monofin athlete during exercise. The patient presented with severe back pain and leg numbness and was managed successfully with conservative treatment. Objective The aim of our communication was to describe a rare presentation of a common pathological condition during an intense sport. Background Swimming is not generally considered to be a sport activity that leads to spinal injuries. SNs are usually asymptomatic lesions, incidentally found on imaging studies. There is no correlation between swimming and symptomatic SN formation. Case Report A 16-year-old monofin elite athlete suffered from an acute nonradiating back pain during extreme exercise. His back pain was associated with a fracture of the superior L5 end plate and an acute SN at the L5 vertebral body with perilesional bone marrow edema. The pain resolved with nonsteroidal anti-inflammatory drugs and bed rest. The athlete had an excellent outcome and returned to his training activities 6 months after his incident. Conclusion SN should be considered in the differential diagnosis of severe back pain, especially in sport-related injuries. SNs present with characteristic imaging findings. Due to the benign nature of these lesions, surveillance-only management may be the best course of action.

Giant fatty Schmorl's nodes: CT findings in four patients

OBJECTIVE

To describe the CT features of an unusual type of lumbar Schmorl's node (SN) appearing as giant fatty lesion of the vertebral bodies.

DESIGN AND PATIENTS

>Four patients (4 men; mean age 48.5 years) collected during a 9-month period were examined with MDCT for unremarkable lumbar symptoms; none had relevant history of specific trauma during the last years preceding the CT.

RESULTS AND CONCLUSIONS

The CT findings had a similar showing: a central or para-central osteolytic lesion in contact with the upper end plate of the vertebra, occupying about two-thirds to three-quarters of the body height and being surrounded by a thin and well-delineated bony rim. There was a clear interruption of the superior vertebral end plate above the lesion and an almost normal height of the adjacent vertebral disk. The CT appearance suggested a uniform fat content which was confirmed by density measurements ranging from -20 to -30 HU. The origin remains unknown, but a parallel is drawn between giant fatty SNs and giant cystic SNs. Intravertebral disk herniation is likely to be the initial phenomenon, with a preponderant responsibility of the "secondary induced intramedullar tissular disorders" to constitute the final size of the lesion. One hypothesis could be a fracture of trabecular bone with secondary hemorrhage and cystic or fatty degeneration. Alternatively, intramedullary vascular disturbances may lead to foci of bone necrosis that heal by fibroblastic proliferation followed by mucoid or fatty degeneration. It is also possible that giant fatty SNs could represent end stage of giant cystic SNs.