Date : 00.00.00
Name of the Patient : Abc Xyzl S. lmn / F / 23 yrs.
Referred by : Dr. Abc Xyznna.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache radiating to BLE with tingling and fever since 2 1/2 months.
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 L5 vertebra appears to be as marked on the film.
There is destruction of the S1 vertebral body with slight forward subluxation of the S1 vertebra over the S2 vertebra. There is replacement of the normal marrow of the S1 and S2 vertebral bodies as well as the sacral ala bilaterally by hypointense signal on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. The S1-S2 intervertebral disc is involved with breach of the adjacent S1-S2 cortical endplates. There is pre and paravertebral soft tissue extension over the L5 to S2 levels. There is involvement of the psoas muscles over the L4 to S2 levels atleast, bilaterally, left more than right (which show an intermediate signal on the T1 Weighted images and turn hyperintense on the T2 Weighted images suggestive of abscess formation). There is anterior epidural extension at the S1 and S2 levels with compression upon the thecal sac. Slight encroachment into the L5-S1 nerual foramina is noted. There is a suggestion of involvement of the ilio-psoas muscles.
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Subtle similar altered signal is also noted in the L4 and L5 vertebral bodies.
The L3-L4 intervertebral disc shows loss of water content.
The rest of the lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. ]
The conus medullaris terminates at the L1-L2 level and the thecal sac terminates at the S2 level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
15.0 mm at L1-L2
15.0 mm at L2-L3
18.0 mm at L3-L4
14.0 mm at L4-L5
17.0 mm at L5-S1.
The MRI features are suggestive of altered signal of the S1 and S2 vertebrae with soft tissue extensions as described is most likely due to a granulomatous infective process like tuberculosis.
The possibility of this being a neoplastic process is less likely.