Date : 00.00.00
Name of the Patient : Abc Xyza S. lmn / F / 21 yrs.
Referred by : Dr. Abc Xyz Ranade.
Examination : M.R.I. of the Dorsal Spine.
CLINICAL PROFILE :
C/O backache with non-healing wound since 3 months.
M.R.I of the dorsal spine was performed using the following parameters :
4 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and T2 Weighted axial images.
There is collapse of the D5 vertebral body. There is replacement of the normal marrow of the superior portion of the D5 and the inferior portion of the D4 vertebral body by hypointense areas on the T1 Weighted images with destruction of the cortical endplates. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. The D4-D5 disc is involved by the disease process with partial destruction. Subtle hypointense signal is identified in the D1, D2 and D3 vertebrae on the T1 Weighted images. The D6, D7, D8 and D9 vertebral bodies also show subtle hyperintense signal on the T2 Weighted images. There is pre and paravertebral soft tissue extension over the D1-D2 to the D9 vertebral levels. This lesion is hypointense with a peripheral hyperintense rim on the T1 Weighted images and turns hyperintense on the T2 Weighted images with a hypointense rim and would represent an abscess formation. The costo-vertebral and costo-transverse joints at the D4-D5, D5-D6, D6-D7 and D7-D8 levels appear to be involved by the pathology.
The rest of the visualized dorsal vertebral bodies and remaining intervertebral discs reveal normal signal intensity. The facet joints are unremarkable.
The visualized dorsal spinal cord reveals normal signal intensity.
The conus medullaris terminates at the L1 level.
An ill-defined lesion is seen in the left upper zone of the lung (se/im:101/6, 7).
The lumbar spine was screened with 4 mm thick T1 Weighted sagittal images and 5 mm thick T1 Weighted axial images which shows a posterior disc herniation at the L4-L5 level with anterior indentation of the thecal sac and left neural foraminal narrowing. There is resultant indentation on the foraminal portion of the left L4 nerve root. Small postero-central disc herniations are noted at the L3-L4 and L5-S1 levels.
Hypointense signal is seen in the L1 vertebral body on the right side with destruction of the superior cortical endplate and involvement of the D12-L1 disc.
The MRI features are suggestive of collapse of the D5 vertebral body with involvement of the D1 to D9 and the L1 vertebrae with pre and paravertebral abscess formation extending over the D1-D2 to D9 vertebral levels as described represents a granulomatous infective process like tuberculosis.
The possibility of a neoplastic process like a round cell tumor is less likely.