Discovery of thoracic meningioma with cord compression on a screening "total body" computed tomography scan

Background context: The use of "total body" screening computed tomography (CT) scans has increased dramatically, although the procedure is controversial, and its benefit to the patient is unproven. When a screening CT scan of the chest is performed, the major areas of interest are the heart and lungs. However, significant portions of the spinal column are also included in the examination. Purpose: To describe a case in which a screening CT scan of the chest revealed clinically important findings within the spinal column. Study design/setting: Case report. Methods: Summary of clinical course a nd imaging studies, with literature review. Results: A healthy 72-year-old woman without neurologic symptoms was self-referred for a screening "total body" CT examination. The chest portion of the study showed a calcified meningioma with cord compression at the T4 level. Within 2 months of the examination, the patient developed a progressive thoracic myelopathy and required excision of the tumor. Definitive management of the tumor was delayed because the patient was not referred for neurologic or neurosurgical consultation at the time of diagnosis. Conclusions: This case illustrate s two important points. First, clinically significant pathology within the spinal column may be identified on a screening CT scan of the chest. Such lesions may have major neurologic implications for the patient. Second, because most patients undergoing screening radiology examinations do not have a referring physician, it is critically important for the radiologist to make prompt referral to a neurologist or neurosurgeon at the time of diagnosis.