Clinical Presentation, Misdiagnosis, and Imaging Findings of Anterior Disc Herniations

Anterior and anterolateral lumbar disc herniations are uncommon and usually do not present with classic radicular symptoms. This contributes to a broader and sometimes misleading differential diagnosis based on the initial presentation. When identified on cross-sectional imaging performed for nonspinal indications, displaced disc material can be mistaken for a retroperitoneal mass, potentially prompting additional imaging or invasive evaluation. We report six cases of anterior and anterolateral disc herniations identified on CT and MRI, including some patients presenting with abdominal or flank pain. Imaging demonstrated anterior disc extrusion, some with marked inflammatory changes. In some cases, the initial diagnosis included retroperitoneal neoplasm or an inflammatory process. Recognizing this imaging pattern and its clinical context may help accurate diagnosis, avoid unnecessary procedures, and guide appropriate management.