Name of the Patient : Abc XyzDlmn / M / 28 yrs.
Referred by : Dr. Abc Xyz Jhaveri.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
Known C/O tuberculous spine with psoas abscess at the L3-L4 level. On AKT since August 0000.
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 L3 and L4 vertebral bodies and the right pedicle of the L4 vertebra. The superior endplate of the L4 vertebra on the right side is eroded with involvement of the L3-L4 intervertebral disc on the right side. The rest of the L3-L4 intervertebral disc is dessicated and this disc is also decreased in height.
There is slight extension of the pathologic process into the anterior epidural space, prevertebral soft tissues and right paravertebral soft tissues at the L3-L4 level.
The rest of the lumbar vertebrae show areas of fatty replacement of normal marrow. The facet joint on the right at the L5-S1 level is slightly hypertrophied.
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 :
17.0 mm at L1-L2
17.0 mm at L2-L3
15.0 mm at L3-L4
14.0 mm at L4-L5
13.0 mm at L5-S1.
The MRI features are suggestive of a pathologic process involving the L3 and L4 vertebrae and the L3-L4 intervertebral disc as described. This most likely represents an infective lesion like tuberculosis.
The possibility of this being a neoplastic process is unlikely.