Date : 00.00.00
Name of the Patient : Abc Xyz Khurlmn / F / 22 yrs.
Referred by : Dr. Abc Xyztchha.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to BLE (left more than right) since 6 months with numbness.
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.
The L4 vertebral body appears hypointense on the T1 Weighted images and heterogeneously hyperintense on the T2 Weighted images. Erosion of the posterior and left lateral margin of the L4 vertebral body is noted with involvement of the left pedicle of L4. There is an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the anterior epidural space and in the left paravertebral region at the L4 vertebral level, which appears hyperintense on the T2 Weighted images. Resultant indentation and probable encasement of the traversing L4 nerve roots bilaterally is noted. There is also extension of the soft tissue lesion in the left neural foramen at the L4-L5 level. The L3-L4 and L4-L5 intervertebral discs show slight loss of water content.
The rest of the lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The facet joints and the visualized pre and right paravertebral soft tissues are unremarkable.
The conus medullaris terminates at the L1 level and the thecal sac terminates at the S2 level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
20.0 mm at L1-L2
19.0 mm at L2-L3
18.0 mm at L3-L4
16.0 mm at L4-L5
15.0 mm at L5-S1.
Altered signal of the L4 vertebral body with erosion of the posterior and left lateral margin of this vertebra with involvement of the left pedicle of L4 as described, most likely represents osteitis, probably tuberculous osteitis. Anterior epidural space and in the left paravertebral soft tissue lesion at the L4 vertebral level may represent granulation tissue.
The possibility of this lesion representing a small cell tumor may be considered as a differential diagnosis.