Date : 00.00.00
Name of the Patient : Abc XyzS. Lalmn / M / 25 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache radiating to BLE since 4 months.
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 replacement of the normal marrow of the L2 and the L3 vertebral bodies by hypointense areas on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. The pedicles of these vertebrae bilaterally and right transverse process of the L2 vertebra are involved by the pathology. The superior and inferior cortical endplates of the L3 and L2 vertebral bodies are breached with involvement of the L2-L3 intervertebral disc. There is pre and right paravertebral soft tissue extension over the L2 to the L4 levels. This lesion is slightly hyperintense to the muscles on the T1 Weighted images and turns heterogeneously hyperintense on the T2 Weighted images and most probably represents an abscess. Few hypointense areas are seen within this lesion on all the pulse sequences which may represent calcification/paramagnetic substances. Anterior and right lateral epidural soft tissue extension is seen over the L2 and L3 vertebral levels. There is encroachment into the right L2-L3 neural foramina with encasement of the foraminal portion of the right L2 nerve root.
Small posterior disc bulges are seen at the L4-L5 and L5-S1 levels. The facet joints at these levels appear hypertrophied.
Suspicious, altered signal is noted in the L4 body.
The rest of the lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The rest of the facet joints are unremarkable.
The conus medullaris terminates at the L1-L2 level and the thecal sac terminates at the S2 level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
17.0 mm at L1-L2
15.0 mm at L2-L3
15.0 mm at L3-L4
14.0 mm at L4-L5
13.0 mm at L5-S1.
The MRI features are suggestive of a pathologic process involving the L2 and L3 vertebrae and the L2-L3 intervertebral disc with extensions as described. This most likely represents an infective lesion like tuberculosis.
The possibility of this being a neoplastic process like a small cell tumor is less likely.