sb/ke
Date : 00.00.00

Name of the Patient : Abc Xyzngh M. Blmn / M / 30 yrs.
Referred by : Dr. Abc Xyzilotri.
Examination : M.R.I. of the Dorso-lumbar Spine.

CLINICAL PROFILE :

H/O fall of a wall while working at the construction site on the back with paraparesis and bladder involvement since 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.

7 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

There is a compression fracture of the D12 vertebral body which is retropulsed and subluxated, laterally, to the right. The D12 vertebral body appears hypointense on the T1 Weighted images and hyperintense on the T2 Weighted images. The laminae and spinous process of D12 are also fractured. Break in the superior and inferior cortical endplate is also noted with a hyperintense signal in the D12-L1 and L1-L2 discs, suggesting traumatic rupture of the discs.

There is an intermediate signal intensity lesion on the T1 Weighted images in the epidural and intradural space extending over the D10 to L2 vertebral levels. This lesion appears hyperintense on the T2 Weighted images. There is resultant cord compression over these levels. The lower dorsal spinal cord over the D9 to the tip of the conus shows a hyperintense signal on the T2 Weighted images suggesting cord edema/ischemia/contusion. It is difficult to differentiate the lower dorsal spinal cord from the intradural hematoma.


There is disruption of the costo-vertebral joints at the D11 and D12 vertebral levels, bilaterally.

There is an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the prevertebral and paravertebral lesions over the D9 to L1 vertebral levels. This lesion appears heterogeneously hyperintense on the T2 Weighted images and most likely represents pre and paravertebral hematoma. Probable right sided pleural collection is noted.

The rest of the visualized dorso-lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The facet joints are unremarkable.

The conus medullaris probably terminates at the L1-L2 level.

The T1 Weighted sagittal images of the lumbar spine reveal a slightly hyperintense signal of the CSF on the T1 Weighted images.

IMPRESSION :

In the given clinical setting of trauma the MRI features suggest compression fracture of the D12 vertebra and traumatic rupture of the D11-D12 and D12-L1 discs. Probable intradural and epidural hematoma is also noted, with cord compression. Cord signal alteration is noted over the D9 to the tip of the conus. It is however, difficult to differentiate the cord from the intra/epidural hematoma in some places. Soft tissue in the pre and paravertebral regions may represent hematoma in the given clinical setting.