Date : 00.00.00
Name of the Patient : Abc Xyza Sulmn / F / 15 yrs.
Referred by : Dr. Abc Xyzshi.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to the RLE since 6 months.
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.
5 mm thick T1 Weighted coronal images.
There appears to be sacralization of the L5 vertebra and the L1 vertebral body is as marked on the film.
There is central wedging of the L3 vertebral body. The L3 vertebra appears hypointense on the T1 Weighted images and heterogeneously hyperintense on the T2 Weighted images. There is erosion of the left pedicle and transverse process of L3. There is a intermediate signal intensity soft tissue lesion on the T1 Weighted images extending from the left half of the L3 vertebral body into the left paravertebral region. This lesion appears hyperintense on the T2 Weighted images. There is resultant lateral displacement of the left psoas muscle in that region. Extension of the soft tissue lesion into the anterior and left lateral epidural space at the L3 level is noted with indentation on the left traversing and exiting L3 and L4 nerve roots, respectively. There is also soft tissue extension into the left neural foramen at the L3-L4 level. There is irregularity of the cortical endplate of the L3 vertebral body. The L2-L3 and L3-L4 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 are unremarkable.
The conus medullaris terminates at the D12 level and the thecal sac terminates at the S1 level.
Fat is noted in the filum terminale at the L1 vertebral level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
17.0 mm at L1-L2
17.0 mm at L2-L3
15.0 mm at L3-L4
11.0 mm at L4-L5
8.0 mm at L5-S1.
1. Sacralization of the L5 vertebra and the L1 vertebral body is as marked on the film.
2. Central wedging of the L3 vertebral body with altered signal most likely represents osteitis, probably tuberculous. Left paravertebral and epidural soft tissue lesion may represent granulation tissue/abscess.
The possibility of the above described lesion representing a neoplasm like a round cell tumor though less likely, cannot be entirely excluded.