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Perineural lumbosacral plexus infiltration is an unusual manifestation of systemic lymphoma that is difficult to diagnose using conventional imaging techniques. We report a case of lymphomatous lumbosacral plexus infiltration that was occult on lumbar MR and abdominopelvic CT imaging. High-resolution MR neurography (MRN) demonstrated a diffusely infiltrating lumbar plexus lesion, suggesting neurolymphomatosis (NL), subsequently confirmed at autopsy. MRN is a sensitive modality for characterizing plexus and peripheral nerve abnormalities1,2⇓ and may be diagnostic after inconclusive conventional MRI. We review NL and demonstrate the diagnostic utility of MRN.
Case report.
A 69-year-old man presented with stage IV thoracic B-cell lymphoma. Four cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by cyclophosphamide produced a full response. One month after completing chemotherapy, he presented again with nocturnal right leg pain exacerbated by lying supine or by extended periods of sitting. The pain became constant and intensified in severity, and examination revealed new bilateral pedal edema. There was severe weakness of the right psoas, quadriceps, and gluteal muscles with moderate involvement of adductor and hamstring muscles. Distal leg …
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