What's the Diagnosis - Case 30

History 62 year old man with increasing right lower extremity pain.

What’s the Diagnosis - Case 30

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What’s the Diagnosis - Case 30

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Findings Images demonstrate a cystic mass associated with the right sided L3/L4 facet joint.

The mass has increased over the two year time period and causes increased mass effect on the right L3 nerve root.

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Diagnosis Facet joints are synovial joints that undergo the same degenerative processes as other joints and inflammatory processes as other joints. Synovial cysts emanate from multiple joints and in the facet joints of the lumbar spine they can cause mass effect on adjacent, critical neural structures. Most common is that the cysts cause compression of the thecal sac, traversing nerve roots, or of the proximal nerve roots. In this circumstance, somewhat less common, the cyst is causing compression of the nerve root in the neural foramen extending to the exit zone of the neural foramen.

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Treatment Under CT guidance, the right L3/L4 facet joint was accessed with the facet cyst filled with contrast. A second needle was then placed into the cyst. After multiple fenestrations, there was a complete resolution of the cyst.

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