sb/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzlodhar Ylmn / M / 65 yrs.
Referred by : Dr. Abc Xyzosle.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE (left more than right) with tingling since 7-8 months.

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 sacralization of the L5 vertebra and the L3 vertebral body is marked on the film. Please correlate with plain radiographs.

The L4, L5 and S1 vertebral bodies show an ill-defined hypointense signal on the T1 Weighted images which turns heterogeneously hyperintense on the T2 Weighted images. The L4 and L5 vertebral bodies and the L4-L5 disc space are reduced in height with irregularity of the cortical endplates adjacent to the L4-L5 intervertebral disc. The L4 and L5 pedicles are also involved.

There is an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the prevertebral soft tissues, along the left psoas muscle extending from about the L3 vertebral level upto the left lateral pelvic wall, in the right paravertebral
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region in the pelvis and in the epidural space on the right (with compression of the thecal sac) over the L4 to S2 vertebral levels. This lesion appears hyperintense on the T2 Weighted images. The lesion along the left psoas muscle most likely represents a psoas abscess. Lesion along the right lateral pelvic wall, prevertebral region and in the epidural space may represent granulation tissue/abscess.

A small posterior disc bulge is noted at the L3-L4 level.

The facet joints at the L3-L4 and L4-L5 levels show mild hypertrophic degenerative changes.

The rest of the lumbar vertebral bodies reveal normal signal intensity.

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 :

20.0 mm at L1-L2
18.0 mm at L2-L3
17.0 mm at L3-L4
13.0 mm at L4-L5
13.0 mm at L5-S1.

Incidentally noted is a fairly large left sided cortical renal cyst.

Screening, T1 Weighted sagittal images of the cervico-dorsal region reveals a congenital block D3/D4 vertebra.
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IMPRESSION :

1. Altered signal of the L4, L5 and S1 vertebral bodies and the L4-L5 intervertebral disc most likely represents osteitis with discitis, probably tuberculous in etiology. Soft tissue lesion along the left psoas muscle represents a psoas abscess. Soft tissue lesion along the right lateral pelvic wall, prevertebral region and in the right lateral epidural space may represent an abscess/granulation tissue.

The possibility of this lesion representing a neoplasm seems less likely.

2. Sacralization of the L5 vertebra. Please correlate with plain radiographs.