Date : 00.00.00
Name of the Patient : Abc XyzRanlmn / F / 65 yrs.
Referred by : Dr. Abc Xyzrankar.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache radiating to the RLE with numbness in BLE since 15 days.
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.
The L3 and L4 vertebral bodies and pedicles appear hypointense on the T1 Weighted images and heterogeneously hyperintense on the T1 Weighted images. The L3-L4 intervertebral disc is also involved and appears hyperintense on the T2 Weighted images.
There is breach in the inferior cortical endplate of the L3 and superior cortical endplate of L4.
There is seen a prevertebral, paravertebral and anterior epidural intermediate signal intensity lesion on the T1 Weighted images at the L3 and L4 vertebral levels which also appear hyperintense on the T2 Weighted images. Resultant slight compression of the thecal sac at the L3-L4 level and also encroachment into the right L3-L4 neural foramen is noted with encasement of the right L3 nerve root.
A posterior and left far lateral disc bulge is noted at the L5-S1 level with indentation on the extraforaminal segment of the left L5 nerve root.
A small posterior disc bulge is noted at the L4-L5 level. Slight facetal hypertrophy is noted at the L4-L5 and L5-S1 levels.
The rest of the visualized lumbar vertebral bodies show fatty marrow changes suggesting osteoporosis. The rest of the lumbar intervertebral discs show loss of water content.
The conus medullaris terminates at the L2 level and the thecal sac terminates at the S1 level.
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The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
17.0 mm at L1-L2
16.0 mm at L2-L3
9.0 mm at L3-L4
13.0 mm at L4-L5
11.0 mm at L5-S1.
Incidentally noted is erosion of the left iliac crest with a soft tissue lesion in that region.
Screening T1 Weighted sagittal images of the dorsal spine reveal fatty marrow changes of the dorsal vertebrae suggesting osteoporotic changes.
Altered signal of the L3 and L4 vertebral bodies and pedicles with involvement of the L3-L4 intervertebral disc most likely represents osteitis with discitis, probably tuberculous in etiology. Prevertebral, paravertebral and anterior epidural soft tissue lesions at these levels most likely represents granulation tissue.
The possibility of a neoplasm like a round cell tumor is less likely.
Erosion of left iliac crest with a soft tissue lesion in that region may represent
another tuberculous focus.