Spinal lesion found on MRI

[violetbaby79]

Hi, I'm a 32 year old woman and my doctor told me that a spinal lesion was seen on a recent MRI I got. This MRI was to investigate a lesion found on my liver, which turned out to be FNH. I have been dealing with a multitude of health problems in the past two years. Please read my history to put this result into context. I've had several abnormal blood tests in the past two year and recently. Please look here: http://www.medhelp.org/posts/Gastroenterology---Digestive-Disorders/Protein-in-urine--Abnormal-ESR--hypodense-area-found-in-liver/show/1606077#post_7298979

I'm very worried about this spinal lesion. Here is what the report says:

"There is a lesion within the right posterolateral aspect of one of the lower thoracic vertebral bodies. This may be within the T11 body. It measures approximately 1.8 cm in maximum dimension. This does demonstrate enhancement on the post-gadolinium enhanced images. It is quite subtle on the T1-weighted images but faintly hypointense. There is relative less drop in the signal intensity on the out of phase images relative to in phase images of this lesion. However, this lesion is nonspecific and could be further characterized with a CT scan examination. A bone scan could also be considered in follow-up."

Please, what does this mean?? My doctor doesn't know. She said it may be a hemangioma...is this consistent with a hemangioma? Could this possibly be cancer?? Help!

[Jana94]

Hello, I am 17 years old, I am girl and I have inborn normotensive hydrocephalus. It has to operate, although for years I live with it and normally I do not have any neurological problems?

[Shiv Kumar, MD]

Dear violetbaby79,

Thanks for posting your query. I appreciate the effort made at providing such a detailed description.

From the description of the details given to me, it looks like you have vertebral body hemangioma. The characteristics of the lesion as seen on your magnetic resonance imaging scan (MRI scan) do not correlate with that of a malignant lesion. A computerised tomography scan (CT scan) and a bone scan can be done to confirm the same but these investigations are optional.

Otherwise, your symptoms of tachycardia fit into the diagnosis of postural orthostatic tachycardia syndrome (POTS). The cause of this syndrome is not fully known. Most patients develop symptoms in their teenage years during a period of rapid growth and see gradual improvement into their mid-twenties. Except for the elevated random cortisol and aldosterone levels, the other tests that have been done for POTS are negative.

Beta blockers like Atenolol can control the sympathetic overactivity seen in POTS. Most patients with POTS will see an improvement in their symptoms over the course of several years, particularly those who develop in their early to mid teens. Most respond to life style changes, in particular drinking extra water and avoiding trigger situations such as standing still or getting hot.

The following dietary changes will prove to be beneficial:

1. Drinking at least 64 ounces (two liters) of water each day.
2. Avoiding alcohol. It exacerbates the symptoms of POTS as it causes vasodilation and dehydration.
3. Eating frequent, small meals and increasing salt intake is beneficial
4. Eating foods with lower carbohydrate levels
5. Caffeine helps some POTS patients due to its stimulant effects
6. Tilting of the head of the bed to an angle of roughly 30 degrees can also help reduce symptoms.
7. Regular muscle strengthening exercises

So I personally feel that you have only a hemangioma (on MRI) which was found incidentally during the evaluation for POTS. I would like to reassure you that no signs of malignancy are currently noted.

Life style changes, dietary habits and medications like Atenolol with benefit you.

I hope I have answered your query. I will be available for follow up queries.

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Best Regards,
Dr Shiva Kumar R