59 years Male (DOB:10/26/1956)Reason: Pt is a 59 y/o male with met prostate cancer, now with worsening back, hip, and leg pain, evaluate for progression of disease, attention to L5 lesion History: back, hip leg pain, L5 lesionReferring Attending: RUSSELL Z SZMULEWITZ 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 intact. No abnormal enhancing lesions are appreciated in the lumbar spine. There is a 16 x 12 mm enhancing focus present within the superior aspect of the L5 vertebral body eccentric towards the left side it is contiguous with the adjacent disc in the adjacent endplates appears to be disrupted it can also be identified on the CT scan from 6/2/2015.There is a 18 x 16 mm sagittal dimension enhancing focus was a cystic central component located within the inferior aspect of the L1 vertebral body which is left of center. This was not evident on the CT scan from 6/2/2015.At L5-S1 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with mild posterior subluxation of L5 on S1 and some partial effacement of the fat at the lateral recess bilaterally. There is some mild facet hypertrophic changes present at this level. Some disc material extends into the right neural foramen at this level and mildly encroaches on the right-sided exiting nerve roots.At L4-5 there is a diffuse disc bulge present associated loss of disc space height and disc desiccation and moderate bilateral facet and ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recess bilaterally at this level. There is triangulation of the thecal sac. Overall there is a mild to moderate spinal stenosis at this level. There are subchondral cysts along the facet joints at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present 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.Findings are concerning for retroperitoneal lymphadenopathy especially at the L4 and L3 vertebral body levels
1.There is an L1 vertebral body lesion present. The possibility this represents metastatic disease cannot be excluded.2.There is an L5 vertebral body lesion present which has a general appearance of a Schmorl's node and has been present on a prior CT scan from last year.3.Findings are concerning for retroperitoneal lymphadenopathy. Please correlate with CT of the abdomen findings4.There are multilevel degenerative changes present in the lumbar spine with mild to moderate spinal stenosis at L4-5 where there is some encroachment of the nerve roots at the lateral recess is as well as mild encroachment of the right-sided exiting nerve roots at L5-S1