Neurofibromatosis

This is a 15 year old girl who presents with multiple freckles in her axilla and multiple cutaneous lesions over the back of her neck. As part of the workup, frontal and lateral radiographs of the chest were obtained. On the frontal radiograph, multiple bilateral paravertebral masses are identified by the red arrows. The green arrows demonstrate subtle notching and indentations along the inferior aspect of multiple ribs bilaterally. The conglomerate of clinical and radiographic findings is consistent with neurofibromatosis. The multiple bilateral paravertebral masses correspond to neurofibromas of multiple thoracic nerve roots. These likely involve multiple neural foramina and extend into the posterior mediastinum. The rib notching is secondary to pressure erosion from neurofibromas extending along the intercostal nerves bilaterally.