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Name of the Patient : Abc Xyza Tlmn / F / 32 yrs.
Referred by : Dr. Abc Xyzrchant.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with pain radiating to BLE with paresthesias.
Alleged H/O fall prior to this.

EXAMINATION :

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.

5 mm thick Fast Scan (T2 *) axial images through the region of interest.

OBSERVATION :

There is an ill-defined, hypointense signal on the T1 Weighted images in the posterior half of the L5 vertebral body. The anterior half of the L5 vertebral body shows a subtle hyperintense signal on the T1 Weighted images. On the T2 Weighted images, linear striations are noted in the L5 vertebral body, which appears uniformly hyperintense. Punctate, signal void areas on all the pulse sequences are noted in the L5 vertebral body, centrally.

There is seen an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the anterior epidural space at the L5 vertebral level. This lesion appears hyperintense on the T2 Weighted images. There is resultant thecal sac compression and indentation on the traversing S1 nerve roots bilaterally.




Slight facetal hypertrophy is noted at the L4-L5 and L5-S1 levels.

The rest of the lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The rest of the facet joints and the visualized pre and paravertebral soft tissues are unremarkable.

The conus medullaris terminates at the D12-L1 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 :

15.0 mm at L1-L2
15.0 mm at L2-L3
12.0 mm at L3-L4
14.0 mm at L4-L5
13.0 mm at L5-S1.

IMPRESSION :

Altered signal in the L5 vertebral body is not specific for a single etiology. The linear striations and the punctate signal void areas favour the diagnosis of a vertebral body hemangioma. The soft tissue lesion in the anterior epidural space at the L5 vertebral level may represent an anterior epidural hematoma from the vertebral body hemangioma (recent h/o fall).

The possibility of the vertebral body lesion representing an infective or a neoplastic lesion and the anterior epidural lesion representing a sequestered disc fragment may be considered as differential diagnosis, though less likely.



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