Date : 00.00.00
Name of the Patient : Abc Xyzaz Anlmn / M / 3 yrs.
Referred by : Dr. Abc Xyzshi.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
H/O fever since 5 months with bilateral abdominal swelling and weakness of BLE.
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.
There is collapse of the L3 and L4 vertebral bodies with replacement of the normal marrow of the L2, L3 and L4 vertebral bodies by hypointense area on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. The L2-L3 and L3-L4 intervertebral discs are involved with erosion of the adjacent cortical endplates and non-visualization of the complete disc with pre and paravertebral soft tissue extensions at the L3 and L4 levels. The psoas muscles bilaterally are bulky and appear hypointense to normal muscles on the T1 Weighted images and turn hyperintense on the T2 Weighted images and represent abscesses. Anterior epidural extension is seen at the L2-L3, L3-L4 and L4-L5 levels with extension into the L2-L3 and L3-L4 neural foramina bilaterally. There is probable encasement of the exiting nerve roots. The thecal sac appears retroplaced at the L3 and L4 levels.
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 L5-S1 level.
The MRI features are suggestive of collapse of the L3 and L4 vertebral bodies with altered signal of the L2, L3 and L4 vertebrae and involvement of the L2-L3 and L3-L4 intervertebral discs with large psoas abscesses and extensions as described is due to granulomatous infective process like tuberculosis.
The possibility of this lesion representing a neoplastic process like a small cell tumor appears less likely.