54-year-old female with low grade fever, swelling and tenderness over lumbar spine x1 mo after a fall. Evaluate for epidural abscess. Five lumbar type vertebral bodies are presumed to be present. There is a compression fracture of the L2 vertebral body with greater than 50% loss of vertebral body height, diffuse enhancement and retropulsion of the posterior superior aspect of the vertebral body into the spinal canal. The conus medullaris terminates just above the level of injury and appears grossly intact. There is T2 signal hyperintensity and enhancement along the right facet and pedicle and to a lesser degree left pedicle. There is no evidence of edema within the cauda equina. No epidural fluid collection is identified. There is an enhancing focus which measures up to 6 mm involving the inferior endplate of the L3 vertebral body. No additional enhancing foci are identified. The bone marrow signal otherwise appears normal.There is focal hypointensity on T1-weighted sequences with enhancement and suggestion of cortical interruption of the right sacral ala consistent with a subacute fracture.Facet and ligamentum flavum hypertrophy involving L4-5 and L5-S1 is also noted.
1.There is an L2 compression fracture present which is eccentric to the left side signal abnormality extends to involve the posterior elements as well especially along the right pedicle and facet suggesting injury in those locations as well. There is approximately 50% loss of vertebral body height. The possibly this represents about the logic fracture is raised.2.There is a right sacral Alla fracture present associated with sclerosis. It is unilateral. The possibility this is pathologic cannot be excluded.3.There is an L3 vertebral body lesion present. This has an atypical appearance. Given the above worry for pathologic fracture is possible this represents a neoplasm cannot be excluded on the basis of this exam alone.4.Findings were discussed with the clinical service.5.There are mild degenerative changes present in the lower lumbar spine mainly related to some facet hypertrophy.Please refer to CT of the same date for further comments.