Differential Diagnosis for Cystic Lesion on Lumbar Imaging
Single Most Likely Diagnosis
- Tarlov cyst: A benign, fluid-filled cyst that forms on the nerve roots of the spine, most commonly in the lumbar and sacral regions. It is a common incidental finding on lumbar imaging and can be asymptomatic or cause symptoms due to compression of adjacent neural structures.
Other Likely Diagnoses
- Synovial cyst: A fluid-filled cyst that arises from the facet joints of the spine. These cysts can cause symptoms by compressing adjacent nerves or the spinal cord.
- Ganglion cyst: A type of cyst that originates from the ligaments or tendons near the spine, which can compress nerves and cause pain or neurological symptoms.
- Arachnoid cyst: A cyst filled with cerebrospinal fluid that forms between the layers of the arachnoid membrane surrounding the spinal cord. It can cause symptoms by compressing the spinal cord or nerve roots.
Do Not Miss Diagnoses
- Epidural abscess: A collection of pus in the epidural space surrounding the spinal cord, which is a medical emergency requiring prompt diagnosis and treatment to prevent serious neurological complications or death.
- Spinal tumor (e.g., neurofibroma, schwannoma): Tumors arising from the nerve roots or other spinal structures can present as cystic lesions on imaging and require early diagnosis for appropriate management.
- Infectious cyst (e.g., hydatid cyst, tuberculous abscess): Cystic lesions caused by infectious agents, which can have serious consequences if not properly treated.
Rare Diagnoses
- Cystic schwannoma: A rare variant of schwannoma, a type of nerve sheath tumor, that contains cystic components.
- Neurenteric cyst: A rare congenital cyst that forms from an abnormal connection between the primitive gut and spinal canal during embryonic development.
- Dermoid cyst: A rare type of cyst that contains skin and sometimes other tissue, which can occur in the spine and may cause neurological symptoms due to compression of the spinal cord or nerve roots.