sb/hs/rg/nl
Name of the Patient : Abc Xyz Shlmn / M / 17 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Cervical Spine.
CLINICAL PROFILE :
C/O neck pain with paresthesias and wasting and weakness of the RUE since 1 month. Swelling on the right side of the neck is also seen. FNAC of the swelling was suggestive of tuberculous lymphadenitis.
EXAMINATION :
M.R.I of the cervical spine was performed using the following parameters :
4 mm thick T1 Weighted and T2 Weighted sagittal images.
6 mm thick T1 Weighted and Fast Scan (T2 *) axial images.
4 mm thick T1 Weighted and T2 Weighted (with fat saturation) coronal images.
OBSERVATION :
There is loss of normal cervical lordosis and slight loss of water content of the C6-C7 intervertebral disc.
There is evidence of a fairly large, intermediate signal intensity soft tissue mass lesion on the right side of the neck and in the posterior paraspinal region and extending from about the C1-C2 level upto to the D2 vertebral level. The lesion is deep to the trapezius muscle in the right posterior paraspinal region and is deep to the sternocleidomastoid muscle in the right paravertebral region. The lesion is seen to extend into the extrapleural space into the right hemithorax. There is also extension of the lesion into the right lateral epidural space over the C5 to D2 vertebral levels with resultant mild cord compression and slight displacement of the spinal cord to the left. The cervical spinal cord, however, shows normal signal intensity.
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There is an ill-defined hyperintense signal on the Fast Scan (T2 *) images in some of the appendages of the C5 to D2 vertebrae on the right. This signal appears hypointense on the T1 Weighted images and would suggest involvement of these appendages. The C6 vertebral body on the right also shows a subtle hyperintense signal on the T2 Weighted and Fast Scan (T2 *) images.
The rest of the cervical vertebral bodies and the remaining intervertebral discs show normal signal intensity.
The cervical spinal cord reveals normal signal intensity.
The atlanto-axial region and the cervico-medullary junction are unremarkable.
Small subcentimeter lymphnodes are noted deep to the sternocleidomastoid muscles bilaterally.
IMPRESSION :
A fairly large, soft tissue mass lesion on the right side of the neck and in the posterior paraspinal region extending from about the C1-C2 level upto to the D2 vertebral level with extensions as described most likely represents an abscess, probably tuberculous in etiology (in view of the FNAC report s/o tuberculous lymphadenitis).
Altered signal in some of the appendages of the C5 to D2 vertebrae on the right may suggest their involvement by the pathologic process.