Date : 00.00.00
Name of the Patient : Abc Xyza Kulklmn / F / 26 yrs.
Referred by : Dr. Abc Xyzngsarkar.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache radiating to the LLE with paresthesias since 2-3 months.
H/O tuberculosis of the left acromio-clavicular joint 2 months back. On AKT since then.
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.
There is an ill-defined, hypointense signal on the T1 Weighted images in the bodies of the L4 and L5 vertebrae. This signal appears hyperintense on the T2 Weighted images. Involvement of the left pedicle and transverse process of the L4 and L5 vertebrae is noted.
There is an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the left posterior paraspinal muscles, in the region of the left transverse process, at the L4 vertebral level. This lesion appears hyperintense on the T2 Weighted images. The left facet joint is involved at that level. Minimal soft tissue extension is noted along the anterior margin of the left transverse process at the L5 vertebral level. Indentation on the foraminal segments of the left L4 and L5 nerve roots is noted by the above described soft tissue lesion.
The rest of the lumbar vertebral bodies and the intervertebral discs reveal normal signal intensity. The remaining facet joints are unremarkable.
The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1 level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
20.0 mm at L1-L2
20.0 mm at L2-L3
19.0 mm at L3-L4
15.0 mm at L4-L5
15.0 mm at L5-S1.
Screening, T1 Weighted coronal images of the S. I. joints do not reveal any significant feature of note.
Altered signal of the L4 and L5 vertebral bodies with involvement of the left sided pedicle and transverse process of these vertebrae, is not specific for a single etiology. In a known C/O tuberculosis of the left acromio-clavicular joint these changes may suggest tuberculous osteitis. Soft tissue in the left paraspinal muscles may represent granulation tissue/abscess.
The possibility of this lesion representing a neoplasm seems less likely.