Date : 00.00.00

Name of the Patient : Abc Xyzal Ralmn / M / 68 yrs.
Referred by : Dr. Abc Xyzrani.
Examination : M.R.I. of the Dorso-lumbar Spine.

CLINICAL PROFILE :

H/O L4-L5 laminectomy 1 month back.
C/O pain and swelling over BLE with fever (on and off) since then with incontinence of urine since 3 days.
Known diabetic. On Rx.

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.

5 mm thick T1 Weighted and T2 Weighted axial images.

After administration of contrast the following parameters were used :

5 mm thick T1 Weighted sagittal and axial images with fat saturation.

6 mm thick T1 Weighted coronal images.

5 mm thick STIR coronal images.

The dorsal spine was screened with 5 mm thick T1 Weighted sagittal images with fat saturation.

FEW IMAGES SHOW PATIENT MOTION INSPITE OF SEDATION.

OBSERVATION :

There is evidence of a laminectomy of the L5 vertebra.

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Areas of hypointensity on the T1 Weighted images which turn hyperintense on the T2 Weighted images are seen to involve the L4 and L5 vertebral bodies and pedicles. After contrast administration the areas within the L4 and L5 vertebrae are seen to enhance. The L4-L5 intervertebral disc is hyperintense on the T2 Weighted images suggestive of its involvement.

Irregularly defined areas of hypointensity on the T1 Weighted images which turn mildly hyperintense on the T2 Weighted images are seen within the epidural space with encasement of the thecal sac at the L4 and L5 vertebral levels. This is seen to extend into the paraspinal soft tissues via the laminectomy defect. This lesion is also seen to enhance and would represent granulation tissue. There is obliteration of the surrounding epidural fat over these levels. There is also extension into the neural foramina bilaterally at the L4-L5 level with encasement of the foraminal L4 nerve roots bilaterally.

Large, lobulated areas of hypointensity on the T1 Weighted images which turn hyperintense on the T2 Weighted images are seen to involve the psoas muscles and in the pre-aortic region from the L3 vertebral level downwards. Inferiorly it is seen to extend into the pelvis and involve the ilio-psoas. The periphery of this lesion shows thick and irregular enhancement and this would suggest an abscess.

Hyperintense signal is identified in the erector spinae group of muscles bilaterally which are seen to enhance after contrast administration.

The intrathecal nerve roots in the lumbar region are ill-defined. Enhancement is noted within the thecal sac and along the periphery of the dorsal cord and this would suggest arachnoiditis.
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The L2-L3, L3-L4 and L5-S1 intervertebral discs show loss of water content.

A posterior disc bulge is noted at the L5-S1 level.

The L2-L3, L3-L4 and L5-S1 facet joints show degenerative changes.

A small effusion is seen within the left hip joint.

IMPRESSION :

The MRI features are suggestive of :

1. Post-operative status.

2. Osteitis with discitis of the L4 and L5 vertebrae and L4-L5 intervertebral disc respectively.

3. Abscess within the psoas muscles and pre-aortic region as described.

4. Granulation tisssue within the epidural space at the L4 and L5 vertebral levels.

5. Arachnoiditis in the dorsal and lumbar region.