Image 1

Image 1

Clinical History:
A 53-year-old woman complaining of severe left leg pain for several months

Incidental lipoma of the conus medullaris

MR Technique:
4 mm axial FSE (13 echoes) pre-contrast T2- and FSE (3 echoes) pre- and post-contrast (the post-contrast scan was acquired with fat saturation) T1-weighted images are presented, acquired at 1.5 T on a Siemens Avanto MR system. Sequence parameters were TR/TE = 3600/106, 794/7.9, and 544/7.9 respectively. Scan times were 2:38, 3:23 and 4:38 min:sec.

Imaging Findings:
At the level of the conus, causing mild deformity therein, is a T1 hyperintense small bilobed mass, with fat signal intensity on both the pre-contrast T1- and T2-weighted scans. There is suppression of the SI of the mass on the post-contrast T1-weighted scan obtained with fat suppression, without abnormal contrast enhancement. These findings are all consistent with a small mass composed of fat, specifically an incidental lipoma of the conus medullaris.

Not illustrated, but present on the scan, was a very large disk herniation at L5-S1, accounting for the patient’s S1 radiculopathy.

A small spinal lipoma, located at the conus, is a not uncommon incidental finding. Although these can occur elsewhere, that is less common. Most lie dorsal to the cord. These lesions are typically round or lobulated, and vary in size.