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Name of the Patient : Abc Xyz Plmn / M / 27 yrs.
Referred by : Dr. Abc Xyzngsarkar.
Examination : M.R.I. of the Dorsal Spine.

CLINICAL PROFILE :

H/O electric shock with fall in the morning of 00.00.0000 with paraplegia since then.

EXAMINATION :

M.R.I of the dorsal spine was performed using the following parameters :

4 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and T2 Weighted axial images.

SOME IMAGES SHOW MOTION ARTIFACTS AS PATIENT WAS IN SEVERE PAIN.

OBSERVATION :

There is forward translation of the D9 over the D10 vertebra with traumatic rupture of the D9-D10 intervertebral disc which appears hyperintense on the T2 Weighted images. Overriding of the facet joints at the D9-D10 level is noted with probable fracture of the laminae and spinous processes of D9 and D10 vertebrae and disruption of the left sided costo-transverse and costo-vertebral joints at the D9 and D10 vertebral levels. Soft tissue lesion in the anterior epidural space at the D9 and D10 vertebral levels and in the pre and left paravertebral space at these levels may represent a small hematoma, in the given clinical setting. The anterior longitudinal ligament appears stripped away from the D10 vertebra. The posterior longitudinal ligament is broken at this level. There is resultant mild cord compression with a hyperintense signal of the dorsal spinal cord on the T2 Weighted images at the D9 and D10 vertebral levels suggesting cord contusion/edema.


There is near complete collapse of the D5 vertebral body. The D4, D5 and the superior half of D6 vertebral bodies appear hypointense on the T1 Weighted images and hyperintense on the T2 Weighted images. The D4-D5 and D5-D6 intervertebral discs are not well defined and are most likely ruptured. Retropulsion of the D4 and D5 vertebrae is noted with fracture of the posterior elements of the D4 and D5 vertebrae, disruption of the facet joints at the D4-D5 level and probable disruption of the left sided costo-vertebral and costo-transverse joints at these levels. A bone fragment is noted in the spinal canal on the left at the D4 and D5 vertebral levels (scans 104.7, 8, 10). There is a circumferential epidural, soft tissue lesion in the spinal canal over the D4 to D6 vertebral levels, with cord compression. The cord over these levels appears thin and also shows a hyperintense signal on the T2 Weighted images suggesting cord contusion/edema, in the given clinical setting.

Soft tissue is noted in the pleural cavities on either side which represents a hemothorax. Fractures of the posterior ends of the ribs are identified at several level.

Screening, T2 Weighted sagittal images of the cervico-dorsal spine do not reveal any significant feature of note.

Screening, T1 Weighted sagittal images of the lumbar spine reveal a slightly hyperintense signal of the CSF, suggesting intrathecal haemorrhage.

Screening, T2 Weighted axial images of the brain are also unremarkable. No extracerebral collection is noted.

The conus medullaris terminates at the L1 level.

IMPRESSION :

The MRI features suggest multiple fractures of the dorsal vertebrae at the D4 and D5 levels and at the D9 and D10 levels as described. There is cord compression at these levels with cord signal alteration suggesting cord contusion/edema. Epidural soft tissue lesions at these levels would represent epidural hematoma. Bilateral hemothorax is also noted.



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