Date : 00.00.00
Name of the Patient : Abc Xyznath lmn / M / 38 yrs.
Referred by : Dr. Abc Xyzrankar.
Examination : M.R.I. of the Dorsal Spine.
CLINICAL PROFILE :
C/O backache since 15 days.
C/O weakness of BLE since 10-12 days.
H/O fall +.
M.R.I of the dorsal spine was performed using the following parameters :
4 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and T2 Weighted axial images.
The L1 vertebra is as marked on the film.
There is a decrease in the height with anterior wedging of the D7 and D8 vertebral bodies.
Areas of hypointensity on the T1 Weighted images which turn heterogeneously hyperintense on the T2 Weighted images are seen to involve the D7 and D8 vertebral bodies and the D7-D8 intervertebral disc. The D7-D8 intervertebral disc appears destroyed and is not well-identified on this scan.
The D4, D5, D6 and D9 vertebral bodies and the D6, D7 and D8 pedicles are similarly involved. The D5-D6 intervertebral disc also appears to be involved.
There is extension of this pathologic process into the anterior epidural space over the D6 to the D8 vertebral level. This lesion is hypointense with a hyperintense rim on the T1 Weighted images and turns hyperintense with a hypointense rim on the T2 Weighted images and may represent an abscess. There is compression upon the cord over these levels. The cord over these levels shows a hyperintense signal on the T2 Weighted images suggestive of cord edema/ischemia/myelitis.
Similar soft tissue lesion is seen in the pre and paravertebral (right more than left) soft tissues over atleast the D5 to D9 levels.
The costo-vertebral joints appear to be involved bilaterally at the D7 and D8 levels and on the right at the D6 and D9 levels.
The rest of the visualized dorsal vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The facet joints are unremarkable.
The conus medullaris terminates at the L1 level.
The MRI features are suggestive of a pathologic process involving the D4 to D9 vertebrae and the D5-D6 and D7-D8 intervertebral discs with soft tissue extension and cord compression with cord edema/ischemia/myelitis as described. This most likely represents an infective process like tuberculosis.
The possibility of this being a neoplastic process like a small cell tumor is less likely.