Diagnosis: Secondary malignant neoplasm of bone and bone marrowClinical question: hx C5 tumor resection and fusion, eval for tumor recurrenceSigns and Symptoms: some mid back pain Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The patient is status post C5 corpectomy and C4-C6 anterior fusion with plate and screws.Since the prior exam from June a mass centered in the right half of the C5 corpectomy site has enlarged from 10x15mm to 31x18mm axial dimensions and now encroaches on the right C5-6 exiting nerve roots and had epidural extension at the right lateral recess. There is redemonstration of associated marrow replacement along the right sided posterior elements of C5. The lesions extends towards the left side of the corpectomy site and left epidural space and mildly narrows the left neural foramen. The mass partially surrounds the right vertebral artery and displaces the right common carotid artery and right jugular vein. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There are small heterogenous lesions present in the thyroid gland.MRI thoracic spine:There is a T5 compression fracture present with 50% loss of vertebral body height. The compression was not present on the prior exam. The mass has significantly enlarged. There is a marrow replacing mass involving all of C5 which protrudes from the vertebral body and right pedicle into the spinal canal and compresses the spinal cord. It predominantly involves the right hemicanal but extends across the ventral midline. It also obliterates the right T5-6 neural foramen. It has enlarged from 21x19mm to 29x23mm axial dimensions. The mass also bulges against the pleura.There is a marrow replacing lesion at T8 which is located at the right anterior aspect of the T8 vertebra currently measuring 21x28mm axial dimensions and previously measuring 19x16 mm axial dimensions. There is enhancement of the majority of the T8 vertebral body.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There appears to be interstitial thickening in the visualized lung which could be better evaluated on CT chest.
1.Since the prior exam a right sided exophytic mass at C5 has significantly enlarged and now encroaches on the right exiting nerve roots at C5-6, partially encases the right vertebral artery and extends into the ventral aspect of the spinal canal and now involves the majority of the corpectomy site and mildly narrows the left neural foramen.2.Progression of T5 mass where there is now a compression fracture associated with cord compression and compression of the right T5-6 exiting nerve roots.3.Interval enlargement of T8 vertebral body mass.4.Please refer to CT chest for further comments.5.An email was sent to Dr Ramos with the above findings.6.Status post C4-5 spinal surgery.