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sb/bv/rg.
Date : 00.00.00

Name of the Patient : Abc XyzDelmn / F / 33 yrs.
Referred by : Dr. Abc Xyzatt.
Examination : M.R.I. of the Dorso-lumbar Spine.

CLINICAL PROFILE :

Left sided radical nephrectomy done for a left sided abdominal mass on 00.00.00. Histopathology s/o ? adrenal cortical carcinoma, ? pheochromocytoma.
Exploratory laprotomy with biopsy of paraaortic nodule was done on 00.00.00. Subsequently received Radiotherapy.
Now C/O backache since 2 months.

EXAMINATION :

M.R.I of the dorso-lumbar spine was performed using the following parameters:

5 mm thick T1 Weighted and T2 Weighted sagittal images.
4 mm thick T1 Weighted sagittal images.
6 mm thick T1 Weighted and T2 Weighted axial images.
6 mm thick T1 Weighted coronal images.

OBSERVATION :

There is still seen an approximately 3.2 x 4.7 x 10.0 cms sized, lobulated intermediate signal intensity mass lesion on the T1 Weighted images in the left paraaortic region along the left antero-lateral margin of the vertebral bodies over about the D10-D11 disc level to about the L2-L3 disc level. This lesion appears heterogeneously hyperintense on the T2 Weighted images with a central hypointense signal in the lesion, superiorly. This lesion is retrocrural in location and is seen posterior to the left crus of the diaphragm. The crus of the diaphragm is displaced antero-laterally. The aorta is also displaced slightly anteriorly by the lesion. Minimal indentation on the medial margin of the spleen is noted.

A separate, focal lesion of similar signal is noted along the posterior abdominal wall at the L1 vertebral level on the left (scans 106.7). This lesion measures about 1.8 cms in maximum transverse dimension.
..2/.





There is a focal hypointense signal on the T1 Weighted images in the L1 vertebral body, antero-laterally on the left. This lesion remains hypointense on the T2 Weighted images and is probably extension of the retrocrural lesion. There is suspicious thinning of the left cortical margin of the L2 vertebra.

The D8 to L3 vertebral bodies show a diffuse hyperintense signal on the T1 Weighted images. This follows fat signal characteristics on all pulse sequences and represents fatty marrow changes, the sequelae of previous radiotherapy.

The L5-S1 intervertebral disc shows loss of water content. A small, right postero-lateral (foraminal) disc herniation is noted at the L5-S1 level with right neural foraminal narrowing.

The patient is status post-left nephrectomy.

The conus medullaris terminates at the L2 level. The visualized lower lumbar spinal cord shows normal signal. There is no cord compression.

IMPRESSION :

An approximately 3.2 x 4.7 x 10.0 cms sized, lobulated mass lesion in the left para-aortic region along the left antero-lateral margin of the vertebral bodies over about the D10-D11 disc level to the L2-L3 disc level with involvement of the L1 vertebra as described most likely represents a recurrence of the previous adrenal mass lesion (as suggested by the Histopathology diagnosis of April 0000). Another lesion is identified at the L1 vertebral level on the left side.

The patient is status post-left nephrectomy and post-radiotherapy.

The preoperative scans were not available for review.

As compared to the previous scan dated 00.00.00 (Study No. 00004) there is increase in the size of the lesion. A new lesion is seen at the L1 level.



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