Bilateral pleural effusion

[biowham]

Found incidentally on t-spine MRI. Can anyone tell me about differential dx? No recent (<15 yr) hx of pneumonia. T-spine MRI shows spinal compression at T6 and T8 (disk compressing) and dorsal compression of unknown cause. Had MS protocol MRI b/c of neuro sx, have lesions on brain.

Neg for relevant sed rate, ANA, etc.

Thanks for any insights.

[HeinrikMD]

Hi,

You are correct, lung cancer may present with the symptoms in the bone before the symptoms in the lung become troublesome. The absence of a mass lesion in the chest raises doubts however - the minimal pleural effusion may be worth exploring, but doesn't seem compelling as evidence of malignancy in the lung. The other cancer with a propensity for presenting with bone metastasis symptoms before the primary site symptoms is renal cell cancer - that may be another avenue to explore. But then, we may be getting ahead of ourselves as we have no evidence the lesion in the MRI really is cancer.

[biowham]

Hi--

Thanks so much for responding. I didn't actually have any pain in the spine when all of this started, but I do now. The presenting sx was actually numbness in my rt foot. I'm not dx'd with MS...in process. The brain lesions were small periventricular white matter lesions, no mass effect.

I do not have any known disease in the lung. I posted here b/c I know that one possible dx is cancer of the lung. The bilateral effusion was an incidental finding on the t-spine MRI that has now gotten me referred to a pulmonologist.

Thanks again for the info.

E

[HeinrikMD]

Hi,

The external compression may simply be a disc prolapse, except that it is uncommon to have one in the thoracic spine. The concern for malignancy is valid – most cancers do involve the thoracic spine. If you had symptoms of pain before there was any problem with movement and sensation – the differentials would include malignancy, abscess (an encapsulated infection), tuberculosis, a hematoma (exsanguinated blood).
There is no clear relationship with MS and cancer. There may be an increased risk (for cancer) with such treatments as Azathioprine but I am assuming that you are newly diagnosed, so this shouldn't be an issue.
The title of your post is bilateral pleural effusion, do you have any known disease in the lung? I never assume that the person posting always does even if this is a lung cancer forum. If there is lung cancer, the bone is a common site of metastasis. Could it also be possible that the brain lesions are likewise metastasis?