Name of the Patient : Abc Xyzlmn / M / 19 yrs.
Referred by : Dr. Abc Xyzwhale.
Examination : M.R.I. of the Sacrum.
CLINICAL PROFILE :
C/O backache with pain radiating to the RLE with incontinence of urine and stool.
M.R.I of the sacrum was performed using the following parameters :
8 mm thick T1 Weighted and 6 mm thick STIR coronal images.
7 mm thick T1 Weighted and T2 Weighted (with fat saturation) axial images.
9 mm thick T2 Weighted (with fat saturation) sagittal images.
There is destruction of nearly all the sacral segments except the S1 segment. The ala of the sacrum on the right is however involved.
There is seen a fairly large, approximately 11.0 x 11.0 x 12.0 cms sized, lobulated heterogeneous signal intensity mass lesion in the sacral and presacral region. This lesion is of intermediate signal on the T1 Weighted images and turns heterogeneously hyperintense on the T2 Weighted images. Focal cystic/necrotic areas are noted within this lesion. There are also focal, hyperintense areas on all the pulse sequences within this lesion which may represent hemoglobin break down products. There is extension of the lesion into the sacral canal. The sacral nerve roots exiting from the sacral foramina are not well-identified
except for the S1 nerve root on the left. There is resultant anterior displacement of the rectum and rectosigmoid colon. The lesion is seen to extend through the sacro-sciatic notch into the right gluteal region, deep to the gluteal muscles. The gluteal muscles on the right side appear atrophied when compared to the left and show a hyperintense signal on the T2 Weighted images (? due to reactive inflammatory change). Laterally the lesion is seen to extend upto the lateral pelvic walls. There is no involvement of the acetabulae or the hip joints on either side, though small hip joint effusions are noted bilaterally. The sacro-iliac joints on either side are however involved by the lesion. No obvious vascular encasement is noted. There are no abnormally enlarged lymph nodes in the pelvis. The bladder is distended with slight indentation upon its posterior aspect without involvement.
A fairly large, lobulated approximately 11.0 x 11.0 x 12.0 cms sized heterogeneous mass lesion in the pelvis involving the sacral segments, with extensions as described, is not specific for a single etiology. The differential diagnosis would include :
2. Sacral chordoma.
3. Less likely to be giant cell tumor/bone cyst.