Spinal Schwannoma Missed on Chest MRI: A Case of Diagnostic Oversight Prevented by Clinical Re-evaluation

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.