Name of the Patient : Abc Xyzbanu Sheralmn / F / 11 yrs.
Referred by : Dr. Abc Xyzmpat.
Examination : M.R.I. of the Dorsal Spine.
CLINICAL PROFILE :
C/O backache with weakness of BLE since 2 days.
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.
After administration of contrast, the following parameters were used :
4 mm thick T1 Weighted sagittal images and 3 mm thick T1 Weighted coronal images (with fat saturation).
5 mm thick T1 Weighted axial images with fat saturation.
There is a subtle hypointense signal on the T1 Weighted images involving the D5 vertebral body, its right transverse process and lamina and its spinous process. This signal appears iso to slightly hyperintense to the rest of the dorsal vertebrae on the T2 Weighted images.
There is seen a fairly well marginated, approximately 1.3 x 1.3 x 4.3 cms sized intermediate signal intensity, epidural mass lesion on the T1 Weighted images in the dorsal spinal canal, extending over the D3-D4 disc level to the D6 vertebral level. This lesion appears hyperintense on the T2 Weighted images and is located posteriorly and to the right of the dorsal spinal cord over these levels. There is resultant cord compression and displacement of the dorsal spinal cord anteriorly and to the left of the midline over the affected vertebral segments. The dorsal spinal cord over these levels shows a subtle hyperintense signal on the T2 Weighted images which suggest cord edema/ischemia. Extension of the soft tissue lesion along the right sided neural foramen at D4-D5 and D5-D6 is noted.
After administration of contrast, there is intense enhancement of the epidural soft tissue lesion in the dorsal region, with an enhancing tail along the superior and inferior margins of the lesion. Patchy enhancement of the right sided transverse process, lamina and spinous process is also noted.
The remaining visualized dorsal vertebral bodies and intervertebral discs reveal normal signal intensity. The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
The conus medullaris terminates at the D12 level.
Screening, images of the cervical and lumbar region do not reveal any significant feature of note.
Altered signal of the D5 vertebra and its posterior elements with an enhancing, epidural soft tissue lesion over the D3-D4 disc level upto the D6 vertebral level as described, is not specific for a single etiology. A neoplasm like a round cell tumor is a likely possibility. An infective lesion like tuberculosis may be considered as a differential diagnosis.
The possibility of a nerve sheath tumor or a meningioma seems less likely.
There is resultant cord compression and cord signal alteration suggesting cord edema/ischemia.