sb/bv/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzur Ralmn / M / 11 mnths.
Referred by : Dr. Abc Xyzankhla.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O swelling in the lumbar region since birth.

EXAMINATION :

M.R.I of the lumbo-sacral spine was performed using the following parameters :

3 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

There is seen a discontinuity in the subcutaneous fat at the lumbo-sacral junction.

There is seen an open lumbo-sacral canal extending from the L5 vertebral level distally. There is seen a CSF signal intensity lesion on all the pulse sequences in the posterior soft tissues in the lumbo-sacral junction extending from the L5 to the S4 vertebral levels. This lesion is in continuity with the thecal sac and represents a meningocele sac. The tip of the spinal cord is seen to extend into this meningocele sac and is probably tethered to it. There is no evidence of an intradural lipoma on this study. The tip of the spinal cord is seen at the S1-S2 level.

The lumbar vertebral bodies and the intervertebral discs reveal normal signal intensity. The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.

IMPRESSION :

The MRI features suggest a meningomyelocele in the lumbo-sacral region with the tip of the spinal cord probably tethered to the meningocele sac at the S1-S2 level.