Diagnosis: Radiculopathy, lumbar regionClinical question: Back pain and h/o metastatic breast cancerSigns and Symptoms: Back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is diffuse heterogeneous marrow replacement throughout the visualized osseous structures of the lumbar spine as well as the sacrum and iliac bones. Compared to the prior exam from 1/14/2015 the foci of marrow replacement appear to be somewhat smaller. For example at the first sacral segment a marrow replacing focus has decreased from 19 x 14 mm sagittal dimensions to 12 x 9 mm sagittal dimension. A similar effect is also noted at other levels as well. An epidural mass with perivertebral extension at the L2, L3 and L4 vertebral body levels is redemonstrated and appears to have regressed somewhat but not resolved. It extends into the left L2-3, L3-4 and L4-5 the neural foramina and encroaches on the exiting nerve roots. It also extends into the perivertebral space as well as the left lateral aspect of the spinal canal at these levels.There is a smaller right-sided perivertebral mass adjacent to the L2 vertebral body which involves right-sided exiting nerve roots at the lateral aspect of the right L2-3 neural foramen.There is a large mass present involving the left iliac bone which is not entirely included on this exam. This measures appears larger. Incidental note is made of multiple perineural cysts in the sacrum which were also present on the prior exam and are stable.
1.There is diffuse skeletal metastases present throughout the visualized lumbar spine, sacrum and iliac bones. These have mildly regressed since the January exam.2.Epidural and left perivertebral mass involving the neural foramina at L2-3, L3-4 and L4-5 - where it involves exiting nerve roots - as well as the spinal canal at these levels has mildly regressed since the prior exam but is not resolved. This is likely metastatic.3.A large left-sided iliac bone mass is incompletely visualized on the current exam. Please refer to MRI of the pelvis of the same date for further comments. This is likely metastatic.