Date : 00.00.00
Name of the Patient : Abc Xyzevi Plmn / F / 15 yrs.
Referred by : Dr. Abc Xyzar.
Examination : M.R.I. of the Cervical Spine.
CLINICAL PROFILE :
C/O neckpain, stiffness and swelling over the left side of neck since 6 months. On AKT since 00.00.00.
M.R.I of the cervical spine was performed using the following parameters :
4 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and Fast Scan (T2 *) axial images.
There is replacement of the normal marrow by hypointense areas on the T1 Weighted images, of the C2, C3, C4 as well as the left lateral mass of atlas. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. There is left paravertebral soft tissue extension of the lesion from the level of the foramen magnum to the C2 level. There is encroachment inbetween the odontoid process and the lateral mass of the atlas bilaterally. This lesion is hypointense to muscle on the T1 Weighted images and turns hyperintense on the T2 Weighted images and would represent an abscess formation. Extension into the left paraspinal muscles is also noted over the C2 to the C3-C4 levels. A large anterior epidural extension is seen over the C2 to the C5 vertebral levels with compression of the spinal cord maximum at the C3 level. The spinal cord at the C3 vertebral level shows a subtle hyperintense signal on the T2
Weighted and Fast Scan (T2 *) images (isointense to normal cord on the T1 Weighted images) suggestive of cord edema/ischemia/myelitis. There is encroachment into the C2-C3 and C3-C4 neural foramina on the right side with encasement of the C3 and C4 nerve roots. There is a suggestion of involvement of the C2-C3, C3-C4 and C4-C5 intervertebral discs.
The rest of the cervical vertebral bodies and the remaining intervertebral discs show normal signal intensity. The joints of Luschka and the visualized prevertebral soft tissues are unremarkable.
The cervico-medullary junction is unremarkable.
Incidental note is made of enlarged deep cervical lymph nodes bilaterally, left more than right.
The dorsal spine was screened with the help of 4 mm thick T1 Weighted sagittal images and 6 mm thick T1 Weighted coronal images which shows hypointense areas replacing the normal marrow of the D5, D6, D7 and D8 vertebral bodies with pre and paravertebral soft tissue extension and probably minimal epidural extension at the D6 level with encroachment into the D6-D7 neural foramen on the left side.
In a known C/O Kochs spine the MRI features suggest involvement of the atlanto-axial region, upper cervical and dorsal vertebrae as described with paravertebral and anterior epidural abscess with granulation tissue.
The possibility of a round cell tumor is less likely.