60 y/o female w/ IgG kappa multiple myeloma, left lower back pain, numbness/tenderness, left lower pelvic area pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 and L5. Alignment is otherwise maintained. Bone marrow signal is benign with no areas of edema or enhancement to suggest active myeloma lesions. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or right neural foraminal stenosis. Cystic enhancing lesion described below involves the inferior lateral aspect of the neural foramen on the left with minimal narrowingL2-L3: Disc bulge and facet arthropathy with suggestion of a small left foraminal disc protrusion. No significant spinal canal or right neural foraminal stenosis. Mild left neural foraminal narrowing. L3-L4: Disc bulge and bilateral facet arthropathy and prominence of the dorsal epidural fat. There is associated mild central spinal canal stenosis as well as mild bilateral neural foraminal stenosis.L4-L5: Disc bulge, moderate bilateral facet arthropathy, and ligamentum flavum thickening contribute to mild spinal canal stenosis. There is mild to moderate bilateral, left greater than right, neural foraminal stenosis.L5-S1: There is minimal disc bulge and mild to moderate bilateral facet arthropathy. There is no significant spinal canal or neural foraminal stenosis. Additional disc bulges are present in the partially imaged lower thoracic spine without high-grade spinal canal stenosis.There is a large cystic structure measuring greater than 7.5 cm in diameter inferior lateral to the right kidney without clear correlate on prior abdominal CT from 5/18/2012. There is a larger pelvic mass likely related to uterine fibroids which is partially imaged and demonstrates mass effect on the left psoas muscle.There is a peripherally enhancing tubular lesion along the posterior aspect of the left psoas muscle which measures approximately 7 x 10 mm in the axial plane and approximately 2.5 cm in the craniocaudal dimension. The lesion appears to course along the extraforaminal left L1 nerve root.There are 3 subcentimeter foci of enhancement involving the bilateral iliac bones and left sacrum.
1. No evidence of active multiple myeloma in the lumbar spine. There are 3 subcentimeter foci of osseous enhancement in the pelvis which are nonspecific but may be related to multiple myeloma.2. Peripherally enhancing fusiform cystic lesion involving the left psoas muscle at the L2 level (7x10 mm in axial plane) may represent an abscess. Neoplasm such as nerve sheath tumor with cystic degeneration (associated with the left extraforaminal L1 nerve root) and resolving hematoma are other considerations. Relative lack of inflammation involving the surrounding left psoas muscle or adjacent discitis-osteomyelitis argue against abscess. 3. Multilevel degenerative changes include grade 1 anterolisthesis at L4 and L5 and mild spinal canal stenosis at the L3-L4 and L4-L5 levels. There is also mild multilevel neural foraminal stenoses. No high-grade spinal canal or high-grade neural foraminal stenosis. Please see additional details above.4. Partially imaged large pelvic mass is compatible with uterine fibroids. There is also a cystic appearing mass inferior lateral to the right kidney without clear correlate on remote abdominal CT from 2012. Consider dedicated abdominal CT for better evaluation.