Name of the Patient : Abc Xyza Shlmn / F / 22 yrs.
Referred by : Dr. Abc XyzGupta.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with pain radiating to the RLE and paresthesias.

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.

OBSERVATION :

There is scoliosis of the lumbar spine with convexity to the right. Altered signal in the noted in sacrum and iliac bone adjacent to the right sacro-iliac joint. This appears hyperintense to normal muscle on the T2 Weighted and FLAIR images and turns hypointense on the T1 Weighted images. Minimal fluid is noted in the right sacro-iliac joint space. Soft tissue intensity is noted within the right sacro-iliac joint space postero-medially eroding adjacent sacru and iliac bone. This probably reprsenrt abcess or granulation tissue. Destruction of right peddicle, right transverse process and right laminae of L3 and L4 vertebral bodies is noted with adjacent soft tissue intensity lesion which most probably reprsent abcess/granulation tissue. This is seen encroaching into the right lateral and posterior aspect of epidural space at the L3 and L4 vertebral levels displacing thecal sac to the left. It also encroaches right neural canal at the L3-L4 and L4-L5 levels. Right peddicle, right transverse process and right laminae adn spinus process of L3 and L5 vertenbral bodies show altered signal with adjacent soft tissuue intensity suggesting their involvement by disease process. The abcess/granulation tissue extends from right sacro-iliac joint involving left paraspinus muscles upto L2 vertebral levels. Posterior part of right phuas and iliac muscles shows altered signal with well-defined lesion within it which appears hyperintnse on the T2 Weighted iamges and isointense to mildly hyperintense on the T1 Weighted iamges as compared to normal muscle. These most likely represent an early phuas muscle.

Mild posteriror disc bulges are noted at the L3-L4, L4-L5 and L5-S1 discs are noted indenting on the thecal sac anteriorly.

The lumbar vertebral bodies and the 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 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 :

14.0 mm at L1-L2
13.0 mm at L2-L3
10.0 mm at L3-L4
10.0 mm at L4-L5
9.0 mm at L5-S1.

IMPRESSION :

Altered signal in the sacrum and iliac bone adjacent to right sacro-iliac bone destruction of right posterior element and spinal processes of L3 and L4 vertebrae as described above. Altered signal in the right posterior element and spinus processes of L3 and L4 vertebral bodies. Adjacent soft tissue intensity suggesting abcess/granulation soft tissue as above. These changes most likely an infective etiology probaly tuberculosis. Possibility of maligant lesion like roun cell tumor appears unlikely.