Uncommon Faces of Disc Herniation: Atypical Imaging Presentations and Mimics

ABSTRACT

Disc herniation is a prevalent pathology encountered in routine clinical practice. Commonly observed pathological conditions such as disc protrusion, extrusion, migration, and sequestration are familiar to most radiologists and frequently documented in standard radiological reports. However, disc herniation can exhibit a broad spectrum of imaging features, which may pose diagnostic challenges for radiologists. This case-based review aims to present intriguing cases with atypical imaging presentations of disc herniation including extraforaminal herniation with a pseudotumoral appearance, massively calcified thoracic disc herniation, posttraumatic acute herniation, gas-containing disc herniation, cement leakage post vertebroplasty simulating disc herniation, and triple cervical disc treatment following sequential development of adjacent segment disease. By discussing their imaging features, we aim to facilitate the differential diagnosis of disc herniation from other entities and thus decrease the incidence of diagnostic errors. Additionally, we seek to provide a comprehensive visual resource that could be of significant educational value in daily clinical practice.

ABBREVIATIONS: ACDF-Anterior Discectomy and Fusion, ASD-Adjacent Segment Disease, ASNR -American Society of Neuroradiology, ASSR-American Society of Spine Radiology, NASS-North American Spine Society, PET-CT -Positron Emission Tomography -Computed Tomography, HU -Hounsfield Units, PNST -Peripheral Nerve Sheath Tumors