Date : 00.00.00
Name of the Patient : Abc Xyza Khlmn / F / 50 yrs.
Referred by : Dr. Abc Xyzoshipura.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to BLE since 6 months with weakness of BLE and bladder/bowel involvement since 2-3 weeks.
M.R.I of the lumbo-sacral 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 a decrease in the height of the L4 vertebral body. Areas of hypointensity on the T1 Weighted images which turn heterogeneously hyperintense on the T2 Weighted images are seen to involve the L3 and L4 vertebral bodies and the antero-superior aspect of the L5 vertebral body. The L4 pedicles are also involved bilaterally as are the L3-L4 and L4-L5 intervertebral discs.
There is extension of this pathologic process into the anterior epidural space at the L3 and L4 vertebral levels with resultant compression upon the thecal sac.
Also seen is extension into the pre and paravertebral soft tissues over the L3 to L5 verterbal levels. A large right psoas muscle lesion (abscess) is also seen with extension into the visualized pelvis. A small right paravertebral component is also noted at the L2 vertebral level.
Posterior disc bulges are noted at the L4-L5 and L5-S1 levels. The L3-L4 and L4-L5 facet joints show degenerative changes.
There is atrophy of the lumbar paraspinal muscles. Also seen is a markedly distended bladder. The rest of the lumbar intervertebral discs show loss of water content.
The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1 level.
The dorsal spine was sceened with 4 mm thick T1 Weighted sagittal images. A large well-defined lesion which is hyperintense to normal muscle is seen in the posterior soft tissues over the D3 to D7 levels and this may represent an abscess.
The MRI features are suggestive of :
1. Areas of altered signal within the L3 and L4 vertebral bodies and the L3-L4 and L4-L5 intervertebral discs with soft tissue extensions as described. This most likely represents a infective process like tuberculosis.
This is less likely to represent a neoplastic process like a small cell tumor or secondaries.
2. A lesion within the posterior soft tissues over the D3 to D7 vertebral levels most likely represents an abscess.