ke/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyznisa Mohd.Almn / F / 25 yrs.
Referred by : Dr. Abc Xyzhiri.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with pain radiating to the LLE with paresthesias in the RLE since 2 years.

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.

4 mm thick T2 Weighted coronal images.

OBSERVATION :

There is scoliosis of the lumbar spine with convexity to the right.

There is replacement of the normal marrow of the L2 and L3 vertebral bodies adjacent to the L2-L3 intervertebral disc by hypointense areas on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. Adjacent cortical endplates are breached with involvement of the L2-L3 disc, more to the left. There is extension of the pathologic process into the left psoas muscles which appears bulky. Hypointense signal is noted on the T1 Weighted images within the left psoas muscle over the L2 to atleast the S1 levels. This is seen to turn hyperintense on the T2 Weighted images. Few hypointense areas within this lesion on all the pulse sequences may represent debris. The lesion most likely represents an abscess.


Small posterior disc bulges are seen at the L3-L4 and L4-L5 levels. The L3-L4 intervertebral disc shows loss of water content.

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

The conus medullaris terminates at the D12 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 :

20.0 mm at L1-L2
19.0 mm at L2-L3
18.0 mm at L3-L4
14.0 mm at L4-L5
13.0 mm at L5-S1.

IMPRESSION :

The MRI features are suggestive of areas of altered signal intensity in the L2 and L3 vertebral bodies with involvement of the L2-L3 intervertebral disc with a left psoas abscess over the L2 to atleast the S1 vertebral levels. This most likely represents an infective pathology like tuberculosis.

The possibility of this being a neoplastic process like a small cell tumor is less likely.