Female, 65 years old, with compression fracture noted on x-rays. Planning examination for kyphoplasty. Thoracic:A compression deformity of the T6 vertebral body is seen with up to 60% loss of height centrally. No significant retropulsion is detected. A compression deformity of the T12 vertebral body is also seen with up to 50% loss of height centrally and mild retropulsion into the left ventral epidural space. Both vertebrae are edematous and both demonstrate heterogeneous marrow enhancement. However, the retropulsed material at T12 does not enhance.An 8 x 5 mm enhancing extramedullary dural based mass is seen within the left ventral thecal sac at T10. This lesion exerts mild mass effect upon the spinal cord but does not produce a significant generalized stenosis. No significant abnormality of the adjacent vertebral body is seen. No other enhancing lesions are detected. The spinal cord demonstrates normal signal intensity throughout.A slight exaggeration of the thoracic kyphosis is seen. Multiple midthoracic vertebrae show mild anterior wedging and generalized reduction in height. The intervertebral discs are preserved. With the exception of the T10 and T12 levels, no other significant compromise of the spinal canal or neural foramina is detected.Pleural effusions are seen, left side greater than right. It also appears that the left upper lobe is atelectatic with a masslike process at the hilum.Lumbar:An expansile enhancing lesion is evident centered on the L3 spinous process and laminae. A round enhancing lesion is seen within the left sacrum, and a large masslike, centrally necrotic process is partially visualized in the left iliac bone. Edema and enhancement of the right L4-5 facet complex is favored to be inflammatory in nature. Vague edema and enhancement within the posterior L1 and L2 vertebral bodies is nonspecific.Vertebral body heights are generally preserved allowing for mild endplate concavity at most levels. Facet arthropathy is seen at lower lumbar levels along with mild disc bulging. No significant spinal canal stenosis is observed. The right L5-S1 neural foramen is mildly narrowed.The visualized distal spinal cord, conus and nerve roots of cauda equina are within normal limits. No definite pathologic intrathecal enhancement is seen.The left adrenal gland is thickened concerning for the presence of a mass.
1.Enhancing osseous lesions within the posterior elements of L3, the left sacrum and the left iliac bone are highly concerning for metastatic deposits. Given this, the compression deformities at T6 and T12 are highly suspected to be pathologic in nature.2.An extramedullary intradural mass is seen within the left ventral thecal sac at T10. Given the above findings, this is concerning for an intradural metastasis, though theoretically this could also represent an incidental meningioma.3.Atelectasis of the left upper lobe and a left hilar mass are suspected. Bilateral pleural effusions are seen. In addition, the left adrenal gland is thickened. These findings should be assessed with dedicated CT imaging.4.The above findings were discussed with Dr. Kallepalli at 4:30 PM on 11/1/16.