ke/sb/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz Lolmn / F / 22 yrs.
Referred by : Dr. Abc Xyzhtekar.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE (left more than right) since 1 year.

EXAMINATION :

M.R.I of the lumbo-sacral 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.

5 mm thick T1 Weighted coronal images.

OBSERVATION :

There is replacement of the normal marrow of the L4 and the L5 vertebral bodies by hypointense areas on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. Subtle altered signal is also seen in the anterior and superior portion of the S1 vertebral body. There is breach in the cortical endplates of the L5 vertebra and the inferior cortical endplate of the L4 vertebral body with involvement of the L4-L5 and L5-S1 intervertebral discs. There is soft tissue encroachment into the L4-L5 neural foramina bilaterally and the L5-S1 neural foramina on the right side with encasement of the exiting nerve roots. There is slight prevertebral soft tissue extension over the L4 to S1 levels. The right psoas muscle is involved by the pathology extending over the L3-L4 disc to iliac levels which appears bulky and shows intermediate signal intensity on the T1 Weighted images and turns hyperintense on the T2 Weighted images. Left paravertebral soft tissue extension is noted over the L3 to S1 levels.



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

The conus medullaris terminates at the D12-L1 level and the thecal sac terminates at the S1 level.

The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :

16.0 mm at L1-L2
16.0 mm at L2-L3
14.0 mm at L3-L4
12.0 mm at L4-L5
14.0 mm at L5-S1.

IMPRESSION :

The MRI features are suggestive of altered signal of the L4 and L5 vertebrae and the L4-L5 and L5-S1 intervertebral discs with extensions as described and most probably represents a granulomatous infective process like tuberculosis. A large right psoas abscess is noted as described.

The possibility of a neoplastic process is less likely.