C2 lesion. Additional history per chart, newly diagnosed left kidney cancer with metastases to lung and bone. There is an enhancing mass measuring approximately 3 cm x 3 cm x 2.5 cm in the AP, transverse, and craniocaudal dimensions centered at the level of the right transverse foramen of C2 with likely encasement of the right vertebral artery. There is osseous destruction and adjacent soft tissue extension. There is involvement of the right C2-C3 neural foramen as well as the right prevertebral muscle structure. There is no extension into the spinal canal. The dens and lamina of C2 remain intact. No additional lesions are seen in the cervical spine.There are small foci of T2 signal abnormality involving the cervical cord including the dorsal paramedian C2-C3 level, right lateral C3 level, and ventral C4 level in the midline.Vertebral body heights in the cervical spine are normal. There is grade 1 anterolisthesis of C3 on C4 as well as minimal retrolisthesis of C5 on C6. There are multilevel degenerative changes as described below: C2-3: No significant compromise to the spinal canal or left neural foramen. Right neural foramen is diffusely involved with tumor.C3-4: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy.C4-5: Small disc osteophyte complex and ligamentum flavum thickening contribute to mild to moderate spinal canal stenosis. There is also mild to moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C5-6: Disc osteophyte complex and ligamentum flavum thickening contribute to mild to moderate spinal canal stenosis. There is also mild to moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C6-7: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.
1. 3 x 3 x 2.5 cm enhancing mass at the right lateral C2 level with involvement of the right C2-C3 neural foramen and encasement of the right vertebral artery is highly suspicious for metastasis. No medial extension into the spinal canal or evidence of mass effect on the cord.2. Small foci of cord signal abnormality from the to C2 to the C4 levels are nonspecific but may be related to demyelinating disease or prior inflammatory myelitis and can be correlated with history. 3. Mild to moderate multilevel degenerative changes in the cervical spine as detailed above.