Asahi Kouichi
Internal Medicine and Pediatrics, Kohokuekimae Ohisama Clinic, Tokyo, JPN.
General Medicine and Radiology, Dokkyo Medical University Saitama Medical Center, Saitama, JPN.
Cureus. 2025 Apr 19;17(4):e82568. doi: 10.7759/cureus.82568. eCollection 2025 Apr.
Spinal schwannomas are benign tumors that can cause significant morbidity if undiagnosed. Misdiagnosis may occur when imaging has a narrow field of view (FOV), especially if clinicians overly rely on radiology interpretations without correlating clinical findings. Here, we report a case of a 58-year-old man who presented with chronic chest and back pain initially attributed to musculoskeletal causes. A non-contrast chest MRI from another hospital was reported as normal. Upon presentation, neurological findings revealed sensory deficits over thoracic dermatomes. The attending physician, board-certified in both general internal medicine and diagnostic radiology, identified a subtle lesion at the edge of the original imaging field. A dedicated contrast-enhanced thoracic spine MRI revealed a tumor consistent with spinal schwannoma at the T7 level. Surgical resection resulted in complete symptom resolution. This case highlights how clinical re-evaluation and imaging reassessment can prevent diagnostic errors associated with a limited FOV and cognitive biases.
脊髓神经鞘瘤是一种良性肿瘤，如果未被诊断出来，可能会导致严重的发病率。当影像学检查的视野（FOV）较窄时，可能会发生误诊，尤其是当临床医生过度依赖放射学解释而不将其与临床发现相关联时。在此，我们报告一例58岁男性病例，该患者最初因慢性胸痛和背痛就诊，病因被归因于肌肉骨骼问题。另一家医院的非增强胸部MRI报告显示正常。就诊时，神经系统检查发现胸段皮节有感觉缺失。这位同时拥有普通内科和诊断放射学专业认证的主治医师，在原始影像视野边缘发现了一个细微病变。专门的增强胸部脊柱MRI显示T7水平有一个与脊髓神经鞘瘤相符的肿瘤。手术切除后症状完全缓解。该病例突出了临床重新评估和影像重新评估如何能够预防与有限视野和认知偏差相关的诊断错误。
