sb/bv/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzh Mlmn / M / 26 yrs.
Referred by : Dr. Abc Xyzunjhunwala.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O pain in the LLE (thigh) with tingling and burning sensation since 2 years.

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.

5 mm thick T1 Weighted coronal images.

OBSERVATION :

There is loss of normal lumbar lordosis.

Small posterior disc bulges are noted at the L4-L5 and L5-S1 levels.

There is seen a fairly large, approximately 3.2 x 4.3 x 4.2 cms sized well-defined intermediate signal intensity mass lesion on the T1 Weighted images in the left psoas muscle, extending over the L2 to L4 vertebral levels. On the T2 Weighted images, the bulk of the lesion appears hyperintense with central hypointense signal. The left psoas muscle is well identified around this lesion. There is also seen a fairly large, similar signal intensity lesion along the left lateral pelvic wall in the left iliac region. This lesion measures approximately 16.0 x 10.0 cms and is seen to indent the lateral margin of the left psoas muscle. The inferior margin of the left kidney is displaced superiorly.
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There are also seen small, lobulated lesions in both the paravertebral regions at the L5-S1, L4-L5, L3-L4 and L2-L3 levels, which follow signal intensity of the above described lesions. These lesions are noted along the exiting nerve roots at the corresponding disc levels and also within the neural foramina bilaterally.

The lumbar vertebral bodies reveal normal signal intensity. The L2-L3 intervertebral disc shows slight loss of water content. The facet joints are unremarkable.

The conus medullaris terminates at the D12-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 :

18.0 mm at L1-L2
18.0 mm at L2-L3
16.0 mm at L3-L4
14.0 mm at L4-L5
12.0 mm at L5-S1.

IMPRESSION :

A fairly large, approximately 3.2 x 4.3 x 4.2 cms sized mass lesion in the left psoas muscle, extending over the L2 to L4 vertebral levels with signal characteristics as described, is not specific for a single etiology. Similar signal intensity, fairly large lesion is also noted along the left lateral pelvic wall in the left iliac region. Multiple lobulated lesions are noted in the paravertebral regions at the L5-S1, L4-L5, L3-L4 and L2-L3 levels.

Multiple neurofibromas may be considered as a likely possibility.

A contrast enhanced scan and a pelvic study would be worthwhile.