Date : 00.00.00
Name of the Patient : Abc Xyzp Glmn / M / 2 months.
Referred by : Dr. Abc Xyzk.
Examination : M.R.I. of the Dorsal Spine.
CLINICAL PROFILE :
Known C/O thoracic meningomyelocele since birth.
H/O V. P. Shunt done 15 days back.
M.R.I of the dorsal 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 probable segmentation anomaly of the D4/D5 vertebrae with spina bifida at that level. A kyphus is noted at this level. There is seen an approximately 3.0 x 1.5 x 3.2 cms sized well-defined mass lesion on the surface of the skin in the upper dorsal region, posteriorly. This lesion is of intermediate signal on the T1 Weighted images and appears hyperintense centrally, on the T2 Weighted images. The lesion is seen to be in communication with the thecal sac at the D4/D5 levels. Probable extension of neural tissue into this soft tissue lesion is noted. The dorsal spinal cord at the D5/D6 levels is puckered and shows a focal hyperintense signal on the T2 Weighted images which may represent a myelomalacic area/syrinx.
The visualized dorsal vertebral bodies reveal normal signal intensity. The visualized pre and paravertebral soft tissues are unremarkable.
Screening T1 Weighted axial images of the brain, reveal moderate dilatation of both the lateral, third and the fourth ventricles.
The MRI features suggests a dorsal meningomyelocele at about the D4/D5 vertebral levels with probable segmentation anomaly of these vertebrae. An area of myelomalacia/syrinx is noted in the dorsal spinal cord at D4/D5 levels. Moderate communicating hydrocephalus is also noted.