Incidentally Detected Thoracic Dumbbell Schwannoma With Intraspinal Extension and Cord Compression: A Case Report.

Schwannomas are benign neurogenic tumors commonly arising in the posterior mediastinum. Although typically asymptomatic, lesions with intraspinal extension may lead to neurological compromise. We report a 47-year-old male who presented with symptoms suggestive of a lower respiratory tract infection and was incidentally found to have a thoracic mass on chest radiography. Further imaging revealed a large, left paravertebral tumor with intrathoracic and intraspinal components extending through the left T7-T8 intervertebral foramina, consistent with a dumbbell schwannoma causing spinal cord compression. Options for surgery include thorax-first, spine-first, combined thoracic-neurosurgical open approaches, thoracoscopic-assisted approaches, and selected minimally invasive paraspinal or transforaminal techniques. Complete macroscopic excision was performed through a coordinated thoracic and spinal surgical approach involving open thoracotomy and foraminotomy. The patient's postoperative period was complicated by a lower respiratory tract infection requiring intravenous antibiotics. However, the patient was neurologically intact at post-op and at one-month follow-up. This case report highlights that large, thoracic dumbbell schwannomas may remain neurologically silent despite significant intraspinal extension and are best managed with a multidisciplinary approach to achieve the best outcomes.