 Images are limited by patient motion. Since the prior outside exam, there has been interval progression of previously seen osseous neoplastic disease at the S1 level. There is now diffuse abnormal signal involving the S1 vertebral body, with more confluent involvement of the right aspect of the sacrum. There is a prominent ventral epidural soft tissue component of tumor with loss of the inferior dorsal cortex of the S1 vertebral body. The epidural tissue measures up to 10 mm in greatest thickness, with near complete effacement of ventral epidural fat and complete effacement of the tapering distal thecal sac at these levels. The abnormal soft tissue spans the L5-S1 to lower S2 levels. Tumor encroaches upon the inferior aspect of the right L5-S1 foramen and appears to efface the right S1-S2 and probable S2-S3 foramina.There is a new area of abnormal signal in the posterior inferior L4 vertebral body system with additional osseous neoplastic disease. More ill-defined lesions are again seen along the superior endplate of L4 anteriorly. Multiple areas of abnormal signal are seen in the L5 vertebral body which appear progressed, with a focal concavity of the superior endplate appears unchanged. A discrete osseous lesion is also present in the L1 vertebral body. There is also a discrete rounded lesion in the left sacrum at the S2-S3 level which appears grossly unchanged.The spine is in normal alignment. There is mild disc narrowing at L4-L5 with loss of normal T2 hyperintense signal. There is also disc narrowing and desiccation at L1-L2. The vertebral body and disk heights are otherwise well-maintained. The spinal cord is of normal caliber and grossly normal signal. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. There is mild developmental narrowing of the mid to distal lumbar spinal canal due to shortened pedicles and prominence of ventral epidural fat.The bladder is severely distended. There is a prominent component of the mass which is presacral in location although incompletely evaluated.
1.Compared to outside exam, there has been interval new thickening progression of osseous neoplastic disease centered at the S1 level, with now a large soft tissue component of ventral epidural tumor which completely effaces the distal thecal sac at this level. This likely accounts for the patient's cauda equina syndrome. Dedicated MRI of the lumbar spine with and without contrast recommended for a full evaluation, when able to tolerate.2.Tumor extends into the right S1-S2 and likely S2-S3 foramina which are completely effaced but incompletely assessed.3.Additional progression of osseous neoplastic disease elsewhere in the lumbar spine. No evidence of other significant central spinal canal stenosis or cord compression, although there is a mildly developmentally slender distal spinal canal.4.Severely enlarged bladder.Dr. Veronesi discussed these findings over the telephone with Dr. Christina Kim on 3/24/2016 12:15 AM, when a preliminary read was requested.