Hiding in Plain Sight: Paravertebral Masses and Mimics

In the era of cross-sectional imaging, the diagnosis of neoplastic, infectious, and reactive paravertebral processes has become more straightforward. Nevertheless, because symptoms are nonspecific, initial detection may be based on chest or abdominal radiographs on which subtle changes can provide the first clues to an underlying abnormality. Through illustrative cases, we review the normal radiographic appearance and companion cases of paravertebral pathology on both radiographs and cross-sectional imaging to highlight subtle changes in regional skeletal and soft-tissue anatomy, which can provide the first clues to masses, traumatic injuries, and infectious and inflammatory processes.

Learning Objective: Because radiographs may be the presenting images of paraspinal processes, the radiologist must recognize subtle distortions of normal anatomy to best guide the next most appropriate imaging examination.