Date : 00.00.00

Name of the Patient : Abc Xyz Plmn / M / 28 yrs.
Referred by : Dr. Abc Xyzl - Orthopaedic Department.
Examination : M.R.I. of the S. I. Joints.

CLINICAL PROFILE :

C/O radicular pain to the RLE (below knee) since 10 days.
H/O backache radiating to the LLE for 1 1/2 months 1 year back from which patient recovered with traction.

EXAMINATION :

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

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

5 mm thick T1 Weighted and STIR coronal images.

OBSERVATION :

There are hypointense areas within the iliac bones bilaterally, the sacral ala (right more than the left), right ischium as well as the pubic bone and the head, neck and upper shaft of the left femur on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the T2 Weighted and STIR images. There is involvement of the right sacro-iliac joint posteriorly. There is extension into the anterior soft tissues at the lower sacral region with involvement of the pyriformis muscle on the right side which is slightly hyperintense to the normal muscle on the T1 Weighted images and turns hyperintense on the T2 Weighted images. There is also extension of this pathology into the spinal canal at the S1/S2 levels on the right side with encasement of the sacral nerve roots (scans 104.9-16)

The left sacro-iliac joint appear normal.

Hyperintense signal is seen in the right gluteus muscle on the T2 Weighted images which could be due to intramuscular injection.
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The cervico-dorsal spine was screened with 5 mm thick T1 Weighted sagittal images and the lumbo-sacral spine was screened with 5 mm thick T2 Weighted sagittal images and 6 mm thick T1 Weighted coronal images which shows hypointense areas in the visualized dorso-lumbar vertebrae. Probable hemangiomas/areas of fatty replacement are noted in the D10 and D5 vertebral bodies.

IMPRESSION :

Altered signal within the iliac bones, the sacral ala (right more than the left), right
ischium as well as the pubic bone and the head, neck and upper shaft of the left femur with involvement the right sacro-iliac joint posteriorly and extending into the anterior soft tissues at the lower sacral region with involvement of the pyriformis muscle and also epidural involvement in the sacral canal with encasement of the
nerve roots on the right side is not specific for a single diagnosis.

The possibilities to be considered are :

1. Multiple metastases.

2. Multifocal tuberculosis.

3. Small cell tumor like multiple myeloma/lymphoma.

A biopsy from the affected bone would be worthwhile.