Date : 00.00.00
Name of the Patient : Abc Xyzda Khalmn / F / 45 yrs.
Referred by : Dr. Abc Xyztchha.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to the LLE with paresthesias.
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.
6 mm thick T1 Weighted and GRASS coronal images.
There is partial collapse of the L3 and L4 vertebral bodies. The L3 and L4 vertebral bodies appear hypointense on the T1 Weighted images and hyperintense on the T2 Weighted images. The L3-L4 intervertebral disc is reduced in height and also appears hyperintense on the T2 Weighted images. There is an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the pre and paravertebral regions extending over the L2-L3 disc level upto the S1 vertebral level. This lesion appears hyperintense on the T2 Weighted images and represents an abscess/granulation tissue. Extension into the anterior epidural space at the L3 and L4 vertebral levels and into the neural foramina at the L3-L4 level, bilaterally is also noted. There is resultant thecal sac compression at the L3 and L4 vertebral levels. The psoas muscles are involved, bilaterally, over the L2-L3 to the S1 levels.
The rest of the lumbar vertebral bodies and the L2-L3 and L5-S1 intervertebral discs reveal normal signal intensity. The facet joints are unremarkable.
The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1 level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
16.0 mm at L1-L2
17.0 mm at L2-L3
7.0 mm at L3-L4
17.0 mm at L4-L5
13.0 mm at L5-S1.
There is also seen altered signal in the sacral and iliac bones adjacent to the left sacro-iliac joints with erosion of its articular margin in some places. Soft tissue is noted in the left neural foramen at the S1-S2 level (scan 104.2). Also seen is involvement of the sacral ala on the right side with extension into the right L5-S1 neural foramen.
Altered signal in the L3 and L4 vertebral bodies and the L3-L4 intervertebral disc suggests osteitis with discitis, most likely tuberculous in etiology. Prevertebral, paravertebral and anterior epidural soft tissue lesion as described represents granulation tissue/abscess.
Involvement of the sacrum and left sacro-iliac joint is also noted.
The possibility of this being a neoplastic process is less likely.