sb/ke/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyz. Glmn / M / 62 yrs.
Referred by : Dr. Abc Xyzrekh.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE with paresthesias since 2 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 central wedging of the L4 vertebral body. The L2, L4 and S1 vertebral bodies show a hypointense signal on the T1 Weighted images which appears slightly hyperintense on the T2 Weighted images. Herniation of the L3-L4 and L4-L5 intervertebral discs into the body of L4 is noted. The posterior margins of the L2 and L4 vertebral bodies are seen to be bulging with resultant thecal sac compression and bilateral neural foraminal narrowing. The superior cortical endplate of L4 is seen to be breached.

Posteriorly bulging discs are noted at the L1-L2 and L2-L3 levels.

Slight facetal hypertrophy is noted in the lumbar region.

The lateral and anterior margins of the L2 and L4 vertebral bodies are also seen to be bulging with minimal soft tissue in the pre and paravertebral regions at these levels and impingement of the L4 nerve roots in the corresponding neural foramen at the L4-L5 level bilaterally.


The lumbar intervertebral discs show slight loss of water content.

The rest of the lumbar vertebral bodies show fatty marrow changes.

The conus medullaris terminates at the L1-L2 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 :

14.0 mm at L1-L2
10.0 mm at L2-L3
13.0 mm at L3-L4
10.0 mm at L4-L5
14.0 mm at L5-S1.

Screening, T1 Weighted sagittal images of the cervico-dorsal region reveals altered signal of the D4 vertebral body with a fairly large left paravertebral soft tissue lesion at the D4 and D5 vertebral levels.

Incidentally noted is altered signal in the right iliac bone and a focal altered signal in the left iliac bone posteriorly.

Small renal parenchymal cysts are noted on the left side.

IMPRESSION :

1. Alterd signal of the L2, L4, S1 and also the D4 vertebral bodies and the iliac bones on either side as described is not specific for a single etiology. The differential diagnosis would include,

a. Metastasis.
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b. Round cell tumor.

c. An infective etiology is less likely.

2. Soft tissue mass lesion in the left paravertebral region at the D4 and D5 vertebral levels is of ? etiology, ? primary lung neoplasm, ?? soft tissue component of the D4 vertebral lesion, ?? lymphnodal enlargement.