Wrap-Around Appearance: Underrecognized Radiologic Feature of Spinal Lymphoma

A 71-year-old man presented with neck and upper back pain to the emergency department. Magnetic resonance imaging of the thoracic demonstrated a T2 vertebral lesion with epidural spinal cord compression. Considering the degree of severe spinal cord compression and the absence of a pathologic diagnosis, an urgent separation surgery was planned. A frozen section of the tumor from the paraspinal mass during initial exposure confirmed the presence of lymphoma, and hence only a T2 laminectomy and decompression were performed. Final pathology was non-Hodgkin lymphoma. Careful evaluation of the magnetic resonance image shows the presence of circumferential epidural spinal cord compression along with involvement of the posterior elements in a characteristic “wrap-around” fashion. Recognition of this finding may steer the surgeon toward a differential of spinal lymphoma, and its clinical importance cannot be overemphasized.