Date : 00.00.00
Name of the Patient : Abc Xyzal Ylmn / M / 60 yrs.
Referred by : Dr. Abc Xyzsari.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache since 6 months.
H/O fever at onset.
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 are hypointense areas on the T1 Weighted images involving the D12, L1 and L2 vertebral bodies and the pedicles of the L1 and L2 vertebrae. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. There is destruction of the L1-L2 disc with erosion of the inferior cortical endplate of the L1 and superior cortical endplate of the L2 vertebrae. The intranuclear cleft is not well visualized.
Similar changes are also seen in the D12-L1 intervertebral disc with the D12-L1 disc appearing more hyperintense than normal on the T1 Weighted images and turning markedly hyperintense on the T2 Weighted images with slight destruction of the superior cortical endplate of L1 and inferior cortical endplate of the D12 vertebrae.
There is also pre and paravertebral extension of the disease process at the D12, L1 and L2 levels. There is encroachment into the L1-L2 neural foramina by the pathology, bilaterally with probable encasement of the nerve roots. There is epidural extension of the disease process at the L1 and L2 levels with compression of the thecal sac.
There is also formation of psoas abscesses bilaterally, the larger one being on the right side over the D12-L1 to atleast the L5 levels.
A postero-central disc protrusion is noted at the L5-S1 level and a mild posterior disc bulge is seen at the L4-L5 level. The L5-S1 intervertebral disc shows loss of water content.
The rest of the lumbar vertebral bodies reveal normal signal intensity.
The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1 level.
Lymphadenopathy is seen in the prevertebral lumbar region.
The MRI features are suggestive of a granulomatous infective process like tuberculosis involving the D12, L1 and L2 vertebrae with involvement of the D12-L1 and L1-L2 intervertebral discs as described. There is also pre/ paravertebral and epidural extension with thecal sac compression and psoas abscesses as described.
The possibility of this being a neoplastic process like a small cell tumor is unlikely.