hs/bv/nl/rg.
Date : 00.00.00

Name of the Patient : Abc XyzChaurlmn / F / 18 yrs.
Referred by : Dr. Abc Xyzhah.
Examination : M.R.I. of the Pelvis.

CLINICAL PROFILE :

C/O backache since 6-7 months with radicular pain to the RLE. C/O swelling over the left side of the low back.
Fever +.

EXAMINATION :

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

6 mm thick T1 Weighted and T2 Weighted (with fat saturation) axial images.

5 mm thick T1 Weighted and STIR coronal images.

Lumbo-sacral spine was screened with 5 mm thick T1 Weighted sagittal images.

OBSERVATION :

The L5 and S1 vertebral bodies show an ill-defined hypointense signal on the T1 Weighted images which turns hyperintense on the T2 Weighted images. The L5-S1 intervertebral disc also appears hyperintense on the T1 Weighted images.

There is an intermediate signal intensity mass lesion on the T1 Weighted images in the prevertebral area, in the lumbo-sacral region, which turns hyperintense on the T2 Weighted and STIR images. This lesion extends into the paravertebral soft tissues on the left and extends along the left lateral pelvic wall into the left inguinal region. The left iliac vessels and left psoas muscle are displaced medially. Extension of the lesion over the left iliac crest is also noted.



There is also seen extension of the soft tissue lesion through the sciatic notch, into the gluteal regions bilaterally, deep to the gluteus maximus muscles. These gluteal lesions extend upto the level of the hip joints on either side. A hypointense signal on all the pulse sequences in the right gluteal region may represent air/calcification. Minimal soft tissue is noted in the anterior epidural space at the L5 and S1 levels with encasement of the L5 nerve roots bilaterally.

The sacral and iliac bones adjacent to the sacro-iliac joints on either side show suspicious hypointense signal. Minimal fluid is noted in the left Sacro-iliac joint with suspicious erosions inferiorly (scans 108.17, 108.18, 108.19). There is also right sacro-iliac joint suspicious involvement inferiorly.

Suspicious paraaortic lymphnodes are seen in the lumbar region.

IMPRESSION :

Altered signal of the L5 and S1 vertebral bodies and the L5-S1 disc suggests osteitis with discitis, most likely tuberculous in etiology. Prevertebral, left paravertebral, left pelvic and bilateral gluteal, soft tissue lesions represent fairly large abscesses.