Date : 00.00.00
Name of the Patient : Abc XyzPlmn / M / 26 yrs.
Referred by : Dr. Abc Xyzalani.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
Alleged H/O railway accident 8 days back with paresthesias in the LLE and pain on the left side of back since 6-7 days.
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.
Areas of hypointensity on the T1 Weighted images which turn heterogeneously hyperintense on the T2 Weighted images are seen to involve the L4 vertebral body. Few linear hypointensities on all the pulse sequences are seen within this vertebral body and may represent compressed trabeculae. The superior cortical endplate of this vertebral body is broken.
There also appears to be a fracture of the spinous process, transverse processes and articular pillars of the L4 vertebra. There appears to be disruption of the interspinous ligament and ligamentum flavum between the L3 and L4 vertebrae.
There is evidence of a space-occupying lesion which is hyperintense to CSF on the T1 Weighted images within the anterior epidural space at the L4 vertebral level with compression upon the thecal sac. This lesion shows mixed signal characteristics on the T2 Weighted images (? epidural hematoma). There also appears to be a similar lesion in the posterior epidural space.
Hyperintense areas on the T2 Weighted images are seen within the paraspinal soft tissues over the L3 to S1 vertebral bodies and may represent soft tissue edema/contusions. There appears to be disruption of the L3-L4 facet joints bilaterally. There also appears to be outpouching of fluid from these joints (right more than left).
The rest of the lumbar vertebral bodies and the intervertebral discs reveal normal signal intensity. The remaining facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
The conus medullaris terminates at the L1-L2 level and the thecal sac terminates at the S2 level.
The cervical and dorsal spines were screened with 4 mm thick T2 Weighted sagittal images and do not show any diagnostic feature of note.
In a known C/O trauma the MRI features are suggestive of fractures of the L4 vertebra, disruption of the interspinous ligament and ligamentum flavum between the L3 and L4 vertebrae with anterior and posterior epidural hematoma with thecal sac compression at the L4 vertebral level. (This is less likely to represent a pathologic process like an infection or neoplasm).