 There are postoperative findings related to L3-L4 laminectomies and posterior spinal fusion at L2-L5 utilizing bilateral pedicle screws and stabilizing rods with posterior paraspinal fluid collection. There is evidence of L2-L5 kyphoplasty. Susceptibility artifact from metallic hardware and lack of intravenous contrast limits evaluation. There is mild anterolisthesis of L4 on L5. The vertebral bone marrow signal is heterogeneous with multiple lesions throughout the imaged axial skeleton. There is mild anterior wedge deformity of the T11 vertebra without significant retropulsion. There is loss of vertebral body heights at T12 through L5 vertebral bodies with posterior retropulsion with epidural tumor extension. There is moderate loss of disc height at T11-12, with mild loss of disc height at the remaining lumbar levels. There is a left prevertebral mass anterior to L3-L5, centered at L4, measuring approximately 2.2 x 5.0 x 9.0 cm (AP x TR x CC), previously 1.4 x 4.7 x 6.8 cm. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is a mass arising from the right iliac wing, measuring up to 5.7 cm in AP dimension (5.5 cm on 3/31/2015 and 4.4 cm on 3/13/2015), which is partially imaged. Incidentally noted is mildly prominent common bile duct measuring up to 1.4 cm. Please correlate for cholecystectomy. A 5 cm wide T2 hyperintense lesion in the right kidney, likely represents a cyst, but is incompletely characterized. The bladder is distended.T12-L1: Approximately 25% loss of vertebral body height at T12 with slightly progressed retropulsion compared to 3/13/2015, but similar compared to 3/31/2015, contributing to mild spinal canal stenosis. Small central disc protrusion. No significant neural foramen stenosis. L1-L2: Approximately 25% loss of vertebral body height at L1 with progression of retropulsion compared to 3/13/2015, but similar compared to 3/31/2015, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild left neural foramen stenosis. L2-L3: Approximately 25% loss of vertebral body height at L2 with progression of retropulsion compared to 3/13/2015, but similar compared to 3/31/2015, disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to moderate spinal canal stenosis and moderate right and mild left neural foramen stenosis. L3-L4: Status post laminectomy. Approximately 25% loss of vertebral body height at L3 with retropulsion, disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis and moderate bilateral neural foramen stenosis. L4-L5: Status post laminectomy. Approximately 25% loss of vertebral body height at L4 with retropulsion, disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to severe spinal canal stenosis and moderate bilateral neural foramen stenosis. L5-S1: Disc bulge, bilateral facet degeneration, and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild to moderate bilateral neural foramen stenosis.
1. Status post posterior spinal fusion at L2-L5 with L3-L4 laminectomies.2. Extensive tumor burden involving the imaged axial skeleton with pathologic fractures and retropulsion with epidural tumor extension involving the T12 through L4 vertebral bodies, most prominent at L3-L4 and L4-5 with severe spinal canal stenosis, and variable degrees of multilevel neural foramen stenosis. The degree of retropulsion and spinal stenosis is slightly progressed compared to 3/13/2015, but similar to 3/31/2015.3. A 5.6 cm right iliac wing mass with progression in size compared to 3/13/2015 is compatible with the known leiomyosarcoma deposit.  Important findings conveyed to Dr. Zimmerman through EPIC mail on 4/9/2015 at the time of dictation. 