Date : 00.00.00
Name of the Patient : Abc Xyz Dablmn / M / 28 yrs.
Referred by : Dr. Abc Xyzhari.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache radiating to BLE (right more than left) since 4 months.
H/O Pulmonary kochs 3-4 years back. Received AKT.
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.
The L5 vertebral body is as marked on the film.
The L2 and L3 vertebral bodies adjacent to the L2-L3 disc show an ill-defined hypointense signal on the T1 Weighted images which turn hyperintense on the T2 Weighted images. The L2-L3 intervertebral disc also appears hyperintense on the T2 Weighted images. Break in the cortical endplates of L2 and L3 vertebrae adjacent to the L2-L3 disc is noted.
There is an intermediate signal intensity mass lesion on the T1 Weighted images in the left psoas muscle, extending over L1 to L4 vertebral levels. This lesion appears hyperintense on the T2 Weighted images and is in continuity of the L2-L3 disc. Extension of this soft tissue lesion into the left neural foramen at the L2-L3 level is noted with encasement of the left L2 nerve root. Similar changes are also noted in the right psoas muscle but to a much lesser extent.
Small posterior disc bulges are noted at the L3-L4 and L4-L5 levels. Facetal hypertrophy is noted at the L3-L4, L4-L5 and L5-S1 levels.
The pedicles of the lumbar vertebrae appear congenitally short in their antero-posterior dimensions.
The rest of the lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The visualized pre and paravertebral soft tissues are unremarkable.
The conus medullaris terminates at the L1 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 :
14.0 mm at L1-L2
14.0 mm at L2-L3
13.0 mm at L3-L4
12.0 mm at L4-L5
12.0 mm at L5-S1.
Altered signal of the L2 and L3 vertebral bodies and of the L2-L3 intervertebral disc suggest osteitis with discitis, most likely tuberculous in etiology. A left psoas abscess is noted as described. A much smaller right psoas abscess is also seen.
The possibility of the above described lesion being a neoplasm seems less likely.