sb/bv/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz Nlmn / M / 25 yrs.
Referred by : Dr. Abc Xyzdi.
Examination : M.R.I. of the Dorsal Spine.

CLINICAL PROFILE :

H/O bullet injury on 4th July 0000.
C/O weakness of BLE since then.

EXAMINATION :

M.R.I of the dorsal spine was performed using the following parameters :

4 mm thick T1 Weighted and T2 Weighted sagittal images.

6 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

The D12 vertebral body is as marked on the film.

The D11, D12 and L1 vertebral bodies show an ill-defined, hypointense signal on the T1 Weighted images which appears hyperintense on the T2 Weighted images. Fracture of the right pedicle and transverse process of the L1 vertebra and the left lateral margin and left pedicle of the D12 vertebra is noted. A fractured fragment is noted in the anterior epidural space along the posterior margin of the D12 vertebral body and in the right lateral epidural space at the L1 vertebral level (scans 105.4, 106.4). The right L1 nerve root in the right neural foramen at the L1-L2 level is not well-identified. The D12 nerve root in the left D12 neural foramen is also not well-identified.

There is an ill-defined, hyperintense signal on the T2 weighted images in the lower dorsal spinal cord over D11 to L1 vertebral levels. This lesion appears predominantly hypointense on the T1 Weighted images. Ill-defined hyperintense signal on all the pulse sequences is also noted within the dorsal spinal cord at the D12 and L1 vertebral
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levels which may represent hemoglobin breakdown products (extracellular methemoglobin). It is difficult to identify the margins of the lower dorsal spinal cord over the D11 to L1 vertebral levels. It is also difficult to exclude a small epidural/intradural haemorrhage on this study.

The CSF in the thecal sac in the lumbar region appears slightly hyperintense when compared to normal on the T1 Weighted images. Suspicious small epidural hematoma is noted, circumferentially around the thecal sac, in the lumbar region.

Ill-defined, hyperintense signal on the T2 Weighted images in the paravertebral and posterior paraspinal soft tissues on the right over the D12 and L1 vertebral levels represent soft tissue injury.

The rest of the visualized dorsal vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The facet joints at the L1-L2, D11-D12, D10-D11 and D9-D10 levels appear slightly hypertrophied. The visualized prevertebral soft tissues are unremarkable.

The conus medullaris is not well identified but probably terminates at the L1 vertebral.

IMPRESSION :

In a known C/O bullet injury,

1. Altered signal of the D11, D12 and L1 vertebral bodies suggests bone bruise with fracture of the right pedicle and transverse process of the L1 vertebra and the left lateral margin and left pedicle of the D12 vertebra.

2. Fractured fragments in the anterior epidural space along the posterior margin of the D12 vertebral body and in the right lateral epidural space at the L1 vertebral level.
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3. Altered signal of the lower dorsal spinal cord over D11 to L1 vertebral levels represents haemorrhagic cord contusion in the given clinical setting.

4. Altered signal of the CSF in the thecal sac in the lumbar region suggest intradural haemorrhage with suspicious small epidural hematoma in the lumbar region.