Name of the Patient : Abc Xyz U. Marlmn / F / 40 yrs.
Referred by : Dr. Abc Xyzla.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to BLE (left more than right)_with paresthesias.
H/O fever +.
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 T2 Weighted (with fat saturation) coronal images.
The L3 and L4 vertebral bodies are decreased in height.
Areas of hypointensity on the T1 Weighted images which turn heterogeneously hyperintense on the T2 Weighted images are seen to involve the L3 and L4 vertebral bodies and the pedicles bilaterally. The L3-L4 intervertebral disc is decreased in height and shows a hyperintense signal on the T2 Weighted images suggestive of its involvement. The cortical endplates adjacent to this disc are eroded.
There is extension of this pathologic process into the anterior epidural space (with compression upon the thecal sac) and the pre and paravertebral soft tissues over the L2-L3 to L4-L5 levels. Also seen is enlargement of the left psoas muscle from the L3 level downwards and this would represent a psoas abscess. Multiple septae are noted in the psoas lesion. The left psoas lesion is seen to extend into the visualized pelvis.
- 2 - Scan-
A small posterior disc herniation is seen to indent the thecal sac and narrow both the neural foramina at the
L4-L5 level. This intervertebral disc shows 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 L1 level and the thecal sac terminates at the S2 level.
The MRI features are suggestive of a pathologic process involving the L3 and L4 vertebral bodies and the L3-L4 intervertebral disc with soft tissue extensions as described. This most likely represents an infective process like tuberculosis.
The possibility of this representing a neoplastic process is less likely.