Name of the Patient : Abc Xyz Deostlmn / M / 28 yrs.
Referred by : Dr. Abc Xyzar.
Examination : M.R.I. of the Cervical Spine.
CLINICAL PROFILE :
C/O pain in the right scapular region and RUE with a weak grip.
M.R.I of the cervical spine was performed using the following parameters :
4 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and Fast Scan (T2 *) axial images.
There is replacement of the normal marrow of the D1 vertebral body by hypointense areas on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. The right pedicle and transverse process of the D1 vertebra is also involved with destruction of the head of the first rib on the right side. There is minimal right paravertebral soft tissue lesion extending over the C7 to the D1-D2 level. Right antero-lateral epidural extension is also noted over these levels with encroachment into the C7-D1 and D1-D2 neural foramina on the right side with encasement of the exiting nerve roots. There is mild indentation upon the right lateral aspect of the spinal cord at the D1 level. The spinal cord however shows normal signal intensity. The right side of the C7 vertebral body is probably involved.
The rest of the cervical vertebral bodies and intervertebral discs show normal signal intensity. The joints of Luschka are unremarkable.
The atlanto-axial region and the cervico-medullary junction are unremarkable.
The dorsal and lumbo-sacral spines were screened with 4 mm and 5 mm thick T1 Weighted sagittal images which show Schmorls nodes in the lower dorsal and lumbar regions with posterior disc bulges at the L3-L4, L4-L5 and L5-S1 levels. Slight central wedging of the D8 and D9 vertebral bodies is noted.
The MRI features are suggestive of altered signal of the D1 vertebral body with involvement of the right pedicle and transverse process and destruction of the head of the first rib on the right side, minimal right paravertebral soft tissue lesion extending over the C7 to the D1-D2 level with right lateral epidural extension over these levels and encroachment into the C7-D1 and D1-D2 neural foramina on the right side with encasement of the exiting nerve roots is most probably due to an infective process like tuberculosis.
The possibility of this being a neoplastic process like a round cell tumor/metastasis should be ruled out.