ke/bv/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz Glmn / M / 37 yrs.
Referred by : Dr. Abc Xyzah / Dr. Abc Xyzehta.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with tingling in BLE since 2-3 months.
H/O fever (on & off) since 1 week.

EXAMINATION :

M.R.I of the lumbo-sacral spine was performed using the following parameters :

5 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

There is slight scoliosis of the lumbar spine with convexity to the left side.

Small posterior disc bulges are seen at the L3-L4 and L4-L5 levels with anterior indentation of the thecal sac.

The L4-L5 facet joints show mild degenerative changes.

The lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The rest of the facet joints and the visualized pre and paravertebral soft tissues are unremarkable.

The conus medullaris terminates at the D12-L1 level and the thecal sac terminates at the S2 level.
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- 2 - Scan-00005

The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :

17.0 mm at L1-L2
17.0 mm at L2-L3
17.0 mm at L3-L4
15.0 mm at L4-L5
12.0 mm at L5-S1.

The dorsal spine was screened with the help of 4 mm thick T1 Weighted sagittal images which does not reveal any diagnostic feature of note.

The abdominal right paraspinal region was further studied with the help of 3 mm thick T1 Weighted and STIR coronal images. A large lesion is seen in the postero-lateral aspect of the right psoas muscle extending over the L2 to the L4-L5 levels and measures approximately 9.0 x 4.0 x 2.5 cms. The periphery of this lesion is hyperintense to muscle on the T1 Weighted images and turns hyperintense on the T2 Weighted and STIR images. The centre of the lesion is hypointense on all the pulse sequences and most probably represents air. An air fluid level is visualized within this lesion. The right psoas muscle appears slightly hyperintense on the STIR images as compared to the opposite side. There is streaking of the perinephrenic fat plane. The left psoas muscle is unremarkable.

IMPRESSION :

A large lesion in the postero-lateral aspect of the right psoas muscle extending over the L2 to the L4-L5 levels and measures approximately 9.0 x 4.0 x 2.5 cms with extensions as described most probably represents an abscess.