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Chordoma : Imaging

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Chordoma - Imaging Studies: Sacrococcygeal region is a common site of involvement and accounts for almost 50% of all chordomas. The tumors can attain large size in this location as they have room to grow and remain asymptomatic initially. Sacrococcygeal chordomas almost always cause pain at the tip of the spinal column. Bowel and bladder symptoms (usually sphincter dysfunction) occur late and are due to pressure effects of the tumor or destruction of nerves emerging from the spinal cord. MRI is superior to CT in delineating soft tissue extension.

Case History: The patient was a 25 y/o female who presented with constipation and a painful sacral mass. MRI showed showed a large soft tissue mass centered upon and destroying the sacrum (sagittal T1 image on the left and sagittal T2 with fat sat. on the right). It measured 8.1 x 9.3 x 11.3 cm. The mass extended anteriorly into the pelvic cavity displacing the uterus and the rectum, upward within the intraspinal canal, and inferiorly to the right side of the perineum. There was heterogenous post-contrast enhancement. It was resected and confirmed to be a chordoma.

Case courtesy of Dr Mostafa El-Feky, Radiopaedia.org. From the case rID: 81612

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