Diagnosis: Malignant neoplasm of unspecified part of unspecified bronchus or lung.Clinical question: New onset sacral boney pain; Hx metastatic NSCLC r/o metastasis to sacrumSigns and Symptoms: New onset sacral boney pain; Hx metastatic NSCLC 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 intactThere is small lesion measuring 10mm in size which is bright on T2 imaging and enhances following contrast administration.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disk dessication and a broad based left lateral recess disk protrusion at this level which encroaches on the nerve roots at the left lateral recess. There is effacement of the fat at the left lateral recess.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild disk dessication and a disk bulge at this level. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild disk dessication at this level.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.
1.A small lesion in the T12 vertebral body could represent a metastatic focus. An atypical hemangioma could be an alternative explanation.2.There are degenerative changes in the lumbar spine mainly in the form of disk degeneration with encroachment of the nerve roots at the left lateral recess at L5-S1. (Most likely affecting the left S1 nerve roots).3.Please note that the lower sacrum (below S3) was not included on this exam. The patient will be asked to return for imaging to include the rest of the sacrum at no expense.