Date : 00.00.00
Name of the Patient : Abc XyzSolmn / M / 49 yrs.
Referred by : Dr. Abc Xyzwhale.
Examination : M.R.I. of the Dorsal Spine.
CLINICAL PROFILE :
Alleged H/O being knocked down by an autorickshaw 8-9 months back with pain in the low back.
C/O weakness of BLE with bladder/bowel involvement since 15 days.
M.R.I of the dorsal spine was performed using the following parameters :
4 mm thick T1 Weighted and T2 Weighted sagittal images.
6 mm thick T1 Weighted and T2 Weighted axial images.
There is replacement of the normal marrow of the D8 and D9 vertebral bodies, pedicles and spinous processes by hypointense areas on the T1 Weighted images. These are seen to turn heterogenenously hyperintense on the T2 Weighted images. There is destruction of the inferior cortical endplate of the D8 and superior cortical endplate of the D9 vertebrae with involvement of the D8-D9 intervertebral disc. This disc appears partially destroyed by the disease process and appears more hyperintense on the T2 Weighted images. Also seen is involvement of the right pedicle and the postero-superior aspect of the body on the right side at the D10 level. There is paravertebral extension of the disease process more marked on the right side. There is also epidural extension with posterior bulging of the D8 and D9 vertebral bodies with cord compression maximum over the D8, D9 and D10 levels. The spinal cord over the D4 to the D11 levels shows a hyperintense signal on the T2 Weighted images and is
suggestive of cord edema/ischemia/myelitis. There is encasement of the D9 and D10 nerve roots by the disease process on the right side and the D9 nerve root on the left side. There is also abscess formation in the right paraspinal muscles over the D8-D9 to the D12 level. There is extension of the posterior epidural collection into the lumbar region upto the S1 level with anterior displacement of the thecal sac and the nerve roots (?? intradural component also). There is involvement of the costo-vertebral and costo-transverse joint at the D8-D9 and the D9 levels on the right side.
A small posterior disc herniation is seen at the L5-S1 level. Also seen are small posterior disc herniations at the D3-D4 and D5-D6 levels.
The rest of the visualized dorsal vertebral bodies and remaining intervertebral discs are unremarkable.
The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1 level.
The MRI features are suggestive of altered signal of the D8 and D9 vertebrae with involvement of the D8-D9 disc and soft tissue extension of the disease process with cord compression and cord signal alteration as described. This strongly suggests a granulomatous infective process like tuberculosis.
The possibility of this being a neoplasm is less likely.