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Date : 00.00.00

Name of the Patient : Abc Xyzndra Salmn / M / 55 yrs.
Referred by : Dr. Abc Xyzrges.
Examination : M.R.I. of the Dorsal & Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE with paresthesias since 2-3 months with weakness of BLE since 2 days.

EXAMINATION :

M.R.I of the dorsal and lumbo-sacral spine was performed using the following parameters :

4 & 5 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

The posterior elements of the D4, D5 and D6 vertebrae and the D3, D6, L1 and L4 vertebral bodies appear hypointense on the T1 Weighted images and are predominantly hypointense on the T2 Weighted images. Minimal extension into the left paravertebral soft tissues is noted at the L4 vertebral level and in the right paravertebral soft tissues at the L1 vertebral level. There is also extension of the soft tissue lesion into the anterior and right lateral epidural space at the D12 vertebral level, the left lateral and posterior epidural space at D5 and D6 vertebral levels and in the anterior epidural space at the D3 vertebral level. There is resultant cord compression at D3, D5 and D6 vertebral levels. The dorsal spinal cord at the D5 and D6 vertebral levels shows a hyperintense signal on the T2 Weighted images suggesting cord edema/ischemia.

Postero-central disc herniations are noted at the L4-L5 and L5-S1 levels and a right postero-lateral disc herniation is noted at the D12-L1 level.


The visualized intervertebral discs show loss of water content.

The rest of the visualized dorsal and lumbar vertebral bodies reveal normal signal intensity. The facet joints are unremarkable.

The conus medullaris terminates at the L1 level and thecal sac terminates at the S2 level.

Incidentally noted is a fairly large, lobulated mass lesion in the upper pole of the left kidney and another suspicious lesion in the left iliac bone.

IMPRESSION :

Altered signal involving the posterior elements of the D4, D5 and D6 vertebrae and the D3, D6, L1 and L4 vertebral bodies with paravertebral and epidural soft tissue lesions as described is not specific for a single etiology. In view of the lobulated mass lesion in the upper pole of the left kidney, these lesions may represent metastatic deposits. The possibility of an infective lesion is less likely.

There is cord compression at D3, D5 and D6 vertebral levels with altered cord signal suggesting cord edema/ischemia.


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