ke/bv/nl/rg.
Date : 00.00.00

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

CLINICAL PROFILE :

C/O backache with numbness in BLE (left more than right).

EXAMINATION :

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

4 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 D3, D4, D6 and D7 vertebral bodies by hypointense areas on the T1 Weighted images which are seen to turn heterogeneously hyperintense on the T2 Weighted images. The right pedicles of the D8, D7, D6 and D4 vertebrae are involved by the pathology.

There is a right paravertebral soft tissue extension over the D3 to D4-D5 levels with involvement of the costo-vertebral and costo-transverse joints at the D3-D4 and D4-D5 levels with involvement of the head of the rib on the right side. There is anterior and right lateral epidural extension with displacement and compression of the spinal cord to the left.

A large right paravertebral soft tissue mass is seen over the D6 to D11 levels with involvement of the costo-vertebral and costo-transverse joints at the D7-D8 and D8-D9 levels. There is involvement of the right paraspinal muscles over the these levels and the right ribs are also involved. Small anterior and large right lateral and posterior epidural extension is noted over the D6 and D7 levels with compression of the cord. The spinal cord at these levels shows a subtle hyperintense signal on the T2 Weighted images and is isointense to cord on the T1 Weighted images suggestive of cord edema/ischemia/myelitis.
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Note is made of enlarged lymph nodes in the pre and paratracheal regions.

The rest of the visualized dorsal vertebral bodies and intervertebral discs reveal normal signal intensity. The facet joints and the visualized prevertebral soft tissues are unremarkable.

The conus medullaris terminates at the L1 level.

The cervico-dorsal spine was screened with the help of 4 mm thick T1 Weighted sagittal images and does not reveal any diagnostic feature of note. The lumbar spine screening shows involvement of the S3 and L3 vertebrae on the right side.

The S I. joints were screened with 5 mm thick STIR coronal images which shows involvement of the left iliac bones, right lower sacral region with adjacent soft tissue extension.

IMPRESSION :

The MRI features are suggestive of altered signal of the D3, D4, D6, D7, L3 and S3 vertebral bodies, left iliac bones, ribs with soft tissue extensions as described and cord signal alteration over the D6 and D7 levels suggesting cord edema/ischemia/myelitis. This most likely represents a granulomatous infective process like tuberculosis.

The possibility of neoplastic process like a round cell tumor or metastasis seems less likely.