Name of the Patient : Abc XyzHuslmn / M / 18 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Cervical Spine.
C/O neck pain radiating to the RUE with wasting of the right shoulder since 2 months.
M.R.I of the cervical spine was performed using the following parameters :
5 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and Fast Scan (T2 *) axial images.
There is mild loss of normal cervical lordotic curve.
There is evidence of a soft tissue lesion within the posterior and right lateral epidural space over the C2 to C7 vertebral levels. This lesion is hyperintense to muscle but hypointense to fat on the T1 Weighted images and turns hyperintense to both on the T2 Weighted and Fast Scan (T2 *) images.
There is erosion of the right lamina and spinous processes of the C4 vertebra with altered signal of the C3, C5 and C6 vertebrae and extension into the right paraspinal soft tissues over these levels. Also seen is encroachment into the right neural foramina at the C3-C4, C4-C5 and C5-C6 levels with encasement of the right vertebral artery (within the foramen transversorium) at the C3 level.
This lesion is seen to compress and displace the cord anteriorly and to the left over the C3 to C6 levels. The cord over these levels shows a hyperintense signal on the T2 Weighted and Fast Scan (T2 *) images suggestive of cord edema/ischemia/myelitis.
Note is made of enlarged lymphnodes within the visualized mediastinum and deep to the sternocleidomastoid muscles, bilaterally.
The cervical intervertebral discs show normal signal intensity. The joints of Luschka are unremarkable.
The atlanto-axial region and the cervico-medullary junction are unremarkable.
The MRI features are suggestive of a soft tissue lesion within the posterior and right lateral epidural space over the C2 to the C7 vertebral levels with cord compression and cord edema/ischemia/myelitis over the C3 to C6 vertebral levels and erosion of the right lamina and spinous process of C4. The differential diagnosis may include,
1. Infective processes like tuberculosis.
2. Neoplasia like small cell tumors.