A 17 year-old female patient with lower back pain, which is radiating down the thigh for three months prior to admission. She had no fever and normal bowel and bladder function. Echocardiogram, blood tests, X-rays, and electrocardiogram showed no abnormalities. Abdominal ultrasound revealed a large lesion in the anterior region of the right psoas muscle and adjacent to the right spine. MRI showed degeneration and central disc protrusion at the L5-S1 level, with no bilateral nerve root compression. The lesion was located in the right pelvic region, anterior to the pelvis and lateral to the psoas muscle.
In the pelvic region (P), anterior to the psoas muscle, extending from the iliac crest to close to the spine, there is a mixed echogenic mass, measuring 98x85x67mm, with increased vascularity.
Café-au-lait spots on the skin, ranging in color from light brown to dark brown, may indicate neurofibromatosis.
Based on the ultrasound findings, along with the observation of the patient's skin with numerous small brown nodules, the diagnosis suggests a retroperitoneal neurofibroma. However, because this structure is close to the spine, a tuberculous abscess is also a possible diagnosis (though less likely).
MRI RESULT
- Degeneration and central disc protrusion at the L5-S1 level, without bilateral nerve root compression.
- Right pelvic lesion, anterior superior pelvis and lateral edge of the psoas muscle, measuring 95x85x78mm, possibly neurofibroma.
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