hs/sb/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzlmn / M / 20 yrs.
Referred by : Dr. Abc Xyzapadia.
Examination : M.R.I. of the Dorsal Spine.

CLINICAL PROFILE :

Known C/O Ewings sarcoma involving the pelvic bones.

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.

The lumbar spine was screened with 5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is evidence of a space-occupying lesion within the posterior epidural space over the D3-D4 to the D5-D6 levels. This lesion is of intermediate signal characteristics on the T1 Weighted images and shows mixed signal characteristics on the T2 Weighted images. It is seen to communicate with a larger lesion in the posterior mediastinum on the left side and the prevertebral region (in the upper and mid dorsal region) via the neural foramina at the D4-D5 and D5-D6 levels. The trachea, esophagus and aorta are displaced anteriorly and to the right. Also seen is involvement of the pedicles and articular pillar of the D4 and D5 vertebrae on the left side as well as the D4 and D5 vertebral bodies and the left D5 transverse process.

The posterior epidural lesion is seen to compress and displace the spinal cord anteriorly and to the right over the D3-D4 to the D5-D6 levels. The cord over these levels shows a hyperintense signal on the T2 Weighted images suggestive of cord edema/ischemia. There also appears to be involvement of the costo-vertebral joints and rib on the left side at the D4-D5 and D5-D6 levels.
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The left pedicle of the D12 vertebra is seen to be expansile and shows a hypointense signal on the T1 Weighted images.

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

The conus medullaris terminates at the D12 level.

IMPRESSION :

In a known C/O Ewings sarcoma the MRI features are suggestive of secondary involvement of the D4 and D5 vertebrae with a posterior epidural component with cord compression and cord edema/ischemia over the D3-D4 to the D5-D6 levels. Also seen is a large mass lesion in the posterior mediastinum on the left side as described.