sb/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz Shlmn / M / 62 yrs.
Referred by : Dr. Abc Xyzauhan.
Examination : M.R.I. of the Dorso-lumbar Spine.

CLINICAL PROFILE :

C/O backache with fever since 4-5 months.
H/O weakness of BLE since 10-15 days.

EXAMINATION :

M.R.I of the dorso-lumbar spine was performed using the following parameters :

5 mm thick T1 Weighted and T2 Weighted sagittal images.
6 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

There is partial collapse of the D12 and L1 vertebral bodies. These vertebral bodies and pedicles appear hypointense to normal marrow on the T1 Weighted images and appear heterogeneously hyperintense on the T2 Weighted images. The D12-L1 intervertebral disc is also involved with erosion of the adjacent cortical endplates. There also appears to be involvement of both the transverse processes of the D12 and L1 vertebrae with probable involvement of the right costo-vertebral joint at D12. There is seen an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the left paravertebral region extending over the D11 to L4 vertebral levels. This lesion appears hyperintense on the T2 Weighted images and shows multiple internal septae suggesting a left psoas abscess. A similar signal intensity lesion, but to a smaller extent is noted in the right paravertebral region extending over the D11 to L3 vertebral levels. Extension of this soft tissue lesion into the D12-L1 neural foramina bilaterally is noted with mild extension into the anterior epidural space at the D12 and L1 levels with mild indentation upon the dorsal spinal cord at these levels. The lower dorsal spinal cord however shows normal signal intensity.


Ill-defined, altered signal (hypointense on the T1 Weighted images and hyperintense on the T2 Weighted images) is also noted in the D11, L3 and L4 vertebral bodies, with probable involvement of the L3-L4 intervertebral disc.

A cystic lesion (isointense to CSF) is noted in the region of the superior pole of the right kidney which may either represent a cortical renal cyst or extension of the right paravertebral abscess into the right suprarenal region (scans 104.12, 105.12).

The rest of the visualized dorso-lumbar vertebral bodies reveal normal signal intensity. The remaining dorso-lumbar intervertebral discs show loss of water content. The facet joints at the D12-L1 level appears slightly hypertrophied.

The conus medullaris terminates at the L1-L2 level.

IMPRESSION :

Partial collapse of the D12 and L1 vertebral bodies with altered signal and involvement of the D12-L1 intervertebral disc as described suggests osteitis with discitis (most likely tuberculous in etiology). Paravertebral soft tissue lesion would represent an abscess. Extension of the abscess into the anterior epidural space is noted at the D12 and L1 levels with minimal cord compression.

Altered signal is also noted in the D11, L3 and L4 vertebral bodies with probable involvement of the L3-L4 intervertebral disc.