Clinical question: possible lumbar hemangiomaSigns and Symptoms: lumbar hemangioma Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. There is mild anterior subluxation of L4-L5 and left lateral translation of L2 on L3. The conus medullaris on sagittal imaging is grossly intact. There is sigmoid curvature to the lumbar spine. Within the sacrum there is a predominantly T2 hyperintense lesion which displays a low but of enhancement and has a spiculated pattern. Part of the lesion is hyperintense on T1. This sacral lesion is 28 x 14 mm greatest sagittal dimensions on the current exam than on the prior exam was 21 x 12 mm sagittal dimensions indicating that it has mildly enlarged.There is a similar signal characteristic lesion present within the T11 vertebral body measuring 15 x 11 mm sagittal dimensions which previously measured 11 x 8 mm sagittal dimensions the previous exam.There is redemonstration of endplate reactive changes at L2-3 where there are Schmorl's nodes present. These endplate reactive changes are lower signal on T1 and higher signal on T2 and have not changed substantially since the prior exam. They do demonstrate enhancement following contrast administration. There is mild left lateral translation of L2 on L3 present. This was also present on prior exam and does not appear to have changed substantially.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy at this level and a mild degree of anterior subluxation of L4 on L5 as well as a small left lateral recess disc protrusion. These findings were also present on the previous exam and have not changed substantively. There is some mild encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.The right ureter and right renal pelvis are larger than on the prior exam. There a mass present in the pelvis which measures approximately 5 cm in diameter. It is eccentric towards the right side and appears to impress on the right ureter.
1.There is redemonstration of a multilevel degenerative changes present in the lumbar spine which have not changed significantly since 2009. This is associated with left lateral translation of L2 on L3, mild anterior subluxation of L4 on L5 and a sigmoid curvature to the lumbar spine as well as some encroachment of the left-sided exiting nerve roots at L4-5 within the neural foramen.2.There is sacral lesion and a T11 lesion present which have mildly enlarged since the prior exam from 2009. These could represent atypical hemangiomas.3.Findings suggest a right-sided hydroureter and hydronephrosis. There appears to be a mass in the pelvis which is incompletely visualized on this exam which impresses on the right ureter. Additional imaging of the pelvis may be of further benefit in evaluating this. Please refer to the MRI of the pelvis from 9/4/2015 for further comments on this.4.An email was sent to Dr Schwartz with the above findings.