Lumbago with sciatica, unspecified side [M54.40], Reason for Study: ^Reason: evaluate for cord irritation History: new buttock and lower back pain, known L1 mets For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are extensive metastatic lesions involving thoracic, lumbar and sacral vertebral bodies as well as bilateral iliac bones and some ribs indicating interval progression since prior scan. Those lesions show enhancement on Gad.In addition, there are multiple various sized new enhancing soft tissue lesions involving paraspinal muscle and subcutaneous tissues which indicate soft tissue metastatic nodules.In particular, the left pedicle of L1 shows high signal intensity on STIR images indicating possible pedicular fracture.The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. There is minimal retrolisthesis of L4 on L5 and L5 on S1.Multilevel disc bulges with bilateral fact joint hypertrophy are seen without causing significant spinal canal stenosis, no change since prior scan.
1. Interval progression of metastatic lesions since prior scan. At this point, those lesions involve lower thoracic and lumbar spine, sacrum and bilateral iliac bones.2. Multiple soft tissue enhancing lesions likely represent metastatic nodules.3. Possible left pedicular fracture of the L1 vertebral body.4. Spinal cord signal intensity appears to be normal.