ke/sb/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz Shlmn / F / 24 yrs.
Referred by : Dr. Abc Xyzthan.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE (left more than right) with paresthesias in the LLE 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.

OBSERVATION :

There is replacement of the normal marrow of the L2 vertebral body on the left side by hypointense areas on the T1 Weighted images. This is seen to turn heterogenously hyperintense on the T2 Weighted images. There is breach in the antero-lateral cortex with extension of the pathology into the left paravertebral soft tissue with involvement of the left psoas muscle over the L1 to L3 levels. This lesion is hypointense on the T1 Weighted images and turns hyperintense on the T2 Weighted images and would represent an abscess formation. Similar but smaller area is seen in the left posterior paraspinal muscles at the L3 and L4 levels. There is a suggestion of involvement of the L1-L2 intervertebral disc.

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

The lower lumbar facet joints appear slightly hypertrophied.



The rest of the lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The rest of the facet joints are unremarkable.

The conus medullaris terminates at the D12-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 :

19.0 mm at L1-L2
17.0 mm at L2-L3
17.0 mm at L3-L4
15.0 mm at L4-L5
16.0 mm at L5-S1.

IMPRESSION :

The MRI features are suggestive of altered signal of the L2 vertebral body on the left side with extensions as described. This is most likely due to a granulomatous infective process like tuberculosis. An abscess formation is seen in the left paravertebral soft tissues with involvement of the left psoas muscle over the L1 to L3 levels and in the left posterior paraspinal muscles over the L3 and L4 levels.

The possibility of this being a neoplastic process like a round cell tumor is less likely.