Back pain, L1 compression fracture and multiple mets. RCC. Evaluate for metastases and cord compression. Exam is limited due to lack of contrast. Marrow signal is overall heterogeneous in appearance. There is evidence of abnormal signal in the thoracic spine with relatively diffuse tumor infiltration involving the T9 vertebral body where there is osseous retropulsion into the ventral epidural space and extension of tumor into bilateral pedicles and right lamina. There is right paravertebral extension of tumor. Abnormal signal is also noted within the superior T10 vertebral body also compatible with metastatic disease.There is complete effacement of the ventral thecal sac at the T9 level with moderate-severe central spinal canal stenosis. Cord signal remains within normal limits without evidence of cord compression. No epidural tumor is seen elsewhere in the thoracic spinal although absence of contrast limits evaluation. There is mild-moderate narrowing of the right T9-T10 neural foramina. At T1-T2, there is a minimal right paracentral disk protrusion with annular fissure indents the ventral thecal sac. There is scattered facet arthropathy throughout the thoracic spine, especially along the mid to lower portions. No significant spinal canal or neural foramina stenosis is seen in the remainder of the thoracic spine.3.6 x 2.7 cm destructive mass is also noted involving the posterior medial aspect of the left third rib extending to the costovertebral junction. There is mild left foraminal narrowing at this level.Vertebral body heights in the thoracic spine are maintained. Alignment is within normal limits although there is straightening of the normal thoracic kyphosis.There is partial visualization of osseous metastatic disease involving the L1 vertebral body with suggestion of involvement of the right pedicle, and mild-moderate narrowing of the right T12-L1 foramen. There is indentation of the right ventral thecal sac.There is incomplete characterization of several nodules associate with the both adrenal glands, better visualized on prior abdominal CT. However, these are suspicious for metastases.
1. Osseous metastatic disease in the thoracic spine as seen on recent CT studies and prior bone scan, predominantly involving T9 extending into the posterior elements. Associated osseous retropulsion into the ventral epidural space with effacement of the ventral thecal sac and moderate-severe central spinal canal stenosis, although without cord compression.2. Left third costovertebral junction destructive metastatic mass.3. Additional partially visualized L1 vertebral metastatic disease.4. Partially visualized bilateral adrenal masses also likely metastatic in origin.