Name of the Patient : Abc Xyzhwaklmn / F / 21 yrs.
Referred by : Dr. Abc Xyzar.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with radiation of pain to the LLE.
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.
The L1 and L5 vertebrae are as marked on the film.
The L3 and L4 vertebral bodies are decreased in height. Areas of hypointensity on the T1 Weighted images which turn heterogeneously hyperintense on the T2 Weighted images are seen to involve the L3 and L4 vertebral bodies and pedicles. The L3-L4 intervertebral disc is involved by the pathologic process.
There is extension of this pathologic process into the anterior epidural space over the L3 and L4 levels with compression upon the thecal sac. Also seen is encroachment into the L2-L3 and L3-L4 neural foramina bilaterally. Also seen is extension into the pre and paravertebral (left more than right) soft tissues over the L2-L3 to L4-L5 levels. There is involvement of the left psoas muscle (abscess) over the L2-L3 to atleast the L5-S1 levels.
The articular facets on the left side at the L4-L5 and L5-S1 levels show hypertrophic changes.
A posterior disc bulge is noted at the L4-L5 level.
Enlarged lumph nodes are noted in the lumbar prevertebral space.
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 L1 level and the thecal sac terminates at the S2 level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
18.0 mm at L1-L2
19.0 mm at L2-L3
11.0 mm at L3-L4
13.0 mm at L4-L5
13.0 mm at L5-S1.
The MRI features are suggestive of a pathologic process involving the L3 and L4 vertebrae and the L3-L4 intervertebral disc with soft tissue extensions as described. This most likely represents an infective process like tuberculosis. The possibility of this being a neoplastic process like a small cell tumor is less likely.