Date : 00.00.00
Name of the Patient : Abc Xyz Dlmn / M / 19 yrs.
Referred by : Dr. Abc Xyzhah.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to the RLE with paresthesias since 1 month.
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 T2 Weighted (with fat saturation) coronal images.
6 mm thick T1 Weighted axial images.
There is loss of water content of the L4-L5 and L5-S1 intervertebral discs.
There is slight central wedging of the L5 vertebral body with herniation of the L4-L5 and L5-S1 intervertebral discs into the body of L5. The L5 vertebral body appears hypointense on the T1 Weighted images and heterogeneously hyperintense on the T2 Weighted images. Erosion of the right sided pedicle and transverse process of L5 vertebra is noted with irregularity of the superior and inferior endplate of L5. There is a right paravertebral and anterior epidural soft tissue lesion at the L4-L5, L5 and L5-S1 levels which is of similar signal characteristics as the L5 vertebral body. There is resultant thecal sac compression and
indentation on the L5 nerve roots bilaterally and the right S1 nerve root. Extension of the soft tissue lesion into the right neural foramen at L5-S1 level is noted with encasement of the foraminal right L5 nerve root.
There is seen a fairly large, approximately 8.0 x 8.0 x 8.8 cms sized well-defined mass lesion in the right paravertebral region, lateral and posterior to the right psoas muscles. This lesion is of intermediate signal on the T1 Weighted images and appears heterogeneously hyperintense on the T2 Weighted images. The centre of the lesion is hypointense on all the pulse sequences. The lesion extends over L2 to L4 vertebral levels. There is indentation on the right psoas muscle and superior and lateral displacement of the right kidney. No extension into the spinal canal is noted. This lesion appears separate from the lesion in the L5 vertebral body.
The rest of the lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The facet joints are unremarkable.
The conus medullaris terminates at the D12 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 :
18.0 mm at L1-L2
17.0 mm at L2-L3
16.0 mm at L3-L4
16.0 mm at L4-L5
12.0 mm at L5-S1.
1. Central wedging of the L5 vertebral body with altered signal and soft tissue component as described is not specific for a single etiology. A round cell tumor/lymphomatous deposit is a likely possibility. A tuberculous etiology seems less likely.
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2. A well-defined approximately 8.0 x 8.0 x 8.8 cms sized mass lesion lateral and posterior to the right psoas muscle (retroperitoneal) with signal characteristics as described is also not specific for a single etiology. The differential diagnosis would include,
a. Lymphomatous deposit.
b. Nerve sheath tumor.
c. Desmoid tumor.
3. The possibility of the L5 vertebral lesion and the right retroperitoneal lesion being metastatic deposits should also be considered as a differential diagnosis.