Date : 00.00.00
Name of the Patient : Abc Xyz V. Slmn / F / 53 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Pelvis & S. I. Joints.
CLINICAL PROFILE :
C/O backache radiating to the RLE with paresthesias and difficulty in bending since April 0000.
M.R.I of the pelvis and S. I. joints was performed using the following parameters :
7 mm thick T1 Weighted and T2 Weighted axial images.
5 mm thick T1 Weighted and STIR coronal images.
6 mm thick T2 Weighted (with fat saturation) sagittal images.
Irregularly defined areas of hypointensity on the T1 Weighted images which turn heterogeneously hyperintense on the T2 Weighted and STIR images are seen to involve sacral vertebral bodies, right sacral ala, right sacro-iliac joint, the right iliac wing and the lamina and articular pillar of the L5 vertebra on the right side. There is extension of this infective process into the paraspinous soft tissues at the L5 vertebral level and in the sacral region. Also seen is extension anteriorly into the pelvis. There is also seen extension into the spinal canal over the S1 to S3 vertebral levels.
Areas with similar signal characteristics are seen to involve the acetabulum and ischal tuberocity with involvement of the obturator internus muscle on the right side and the acetabulum roof, iliac wing and the iliacus muscle on the left side.
The uterus is bulky and anteverted and shows multiple hypointensities which may represent fibroids. A cyst is noted in the region of the right ovary.
There is lateral subluxation of the L4 vertebra over the L5 vertebra on the left side and retroplacement of the L5 vertebra over the S1 vertebra.
There appear to be enlarged lymphnode in the visualized lumbar prevertebral region.
The bladder is seen to be distended.
The MRI features are suggestive of a pathologic process involving the various pelvic bones with soft tissue extensions as described. This is not specific for a single etiology.
The differential diagnosis would include,
1. Infective process like tuberculosis.
2. Neoplastic process like small cell tumors or secondaries.