Date : 00.00.00

Name of the Patient : Abc Xyz Plmn / M / 28 yrs.
Referred by : Dr. Abc Xyzngsarkar.
Examination : M.R.I. of the Pelvis.

CLINICAL PROFILE :

C/O pain in the RLE since 3 months with decreased appetite and loss of weight by 10 kgs.

EXAMINATION :

M.R.I of the pelvis was performed using the following parameters:

7 mm thick T1 Weighted and T2 Weighted axial images.

5 mm thick T1 Weighted coronal images.

The dorsal and lumbar spines were screened with 5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is an ill-defined, hypointense signal on the T1 Weighted images involving the right half of the sacrum including the right sacral ala and the iliac bones on either side adjacent to the sacro-iliac joints posteriorly. These lesions appear hyperintense on the T2 Weighted images. Similar signal intensity changes are noted in the left ischial tuberosity, head and neck of left femur, roof of the acetabulae on either side and probably the iliac crest, bilaterally.

There is seen a fairly large, intermediate signal intensity soft tissue component of the lesion in the presacral region to the right of the midline, extending into the right gluteal region through the sacro-sciatic notch. This lesion appears hyperintense on the T2 Weighted images. Slight extension into the posterior paraspinal muscles on the right and into the sacral canal is also noted.


The right gluteus maximus muscle shows an ill-defined hyperintense signal on the T2 Weighted images which suggests its involvement. The right piriformis muscle also seems to be involved by the lesion. The rectum is displaced slightly anteriorly and to the left of the midline by the soft tissue component of the right sacro-iliac lesion. There are no abnormally enlarged pelvic lymph nodes identified on this study. There is no free fluid in the visualized pelvis.

Screening images of the dorsal and lumbar spine show an ill-defined hypointense signal on the T1 Weighted images involving the majority of the dorsal and lumbar vertebral bodies. Hyperintense signal on the T1 Weighted images in the D7, D9 and L4 vertebral bodies represent hemangioma with fat content.

IMPRESSION :

Altered signal in the right half of the sacrum including the right sacral ala and the iliac bones on either side adjacent to the sacro-iliac joints posteriorly, in the left ischial tuberosity, head and neck of left femur, roof of the acetabulae on either side and probably the iliac crest, bilaterally and in the dorsal and lumbar vertebral bodies as described is not specific for a single etiology.

The differential diagnosis would include :

1. Round cell tumors.

2. Multiple metastases.

3. Multifocal tuberculosis - seems less likely.

A soft tissue component of the lesion is noted in the presacral region on the right at the level of the right sacro-iliac joint extending into the gluteal region and the spinal canal as described.

No previous scans were available for comparison.