Diagnosis: Lumbago with sciatica, right side Lumbago with sciatica, left sideClinical question: hematoma after lumbar drain placementSigns and Symptoms: back pain radiating to both legs Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is no evidence for an epidural mass and no evidence for epidural hematoma appreciated. On the T2 sagittal images there is a T2 hyperintense focus present which is not adequately evaluated on this exam and may represent artifact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is moderate facet hypertrophy, loss of disc space height, disc desiccation and diffuse disc bulge associated with mild anterior subluxation of L4 on L5. There is effacement of the fat at the lateral recess on the right side into a lesser degree effacement of the fat on the lateral recess on the left side. There is mild narrowing of the neural foramina at this level. Some disc material extends behind the L4 vertebral body along its inferior aspect. Overall there is mild spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.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.The visualized upper abdominal aorta measures 3 cm in diameter on axial imaging however superior to this there appears to be enlargement of the aorta up to 5.6 cm AP dimension.
1.There are degenerative changes present in lumbar spine worse at L4-5 where there is mild subluxation and mild degree of narrowing of the spinal canal.2.There is no evidence for epidural hematoma.3.Findings raise the question of thoracic aortic aneurysm possibly with dissection. 4.On the T2 sagittal images there is a T2 hyperintense focus present which is not adequately evaluated on this exam and may represent artifact. Given the possibility of a thoracic aortic dissection a spinal cord infarct cannot be excluded on the basis of this exam . Please correlate with patient's clinical exam findings.5.At the time of this dictation, we spoke to the emergency room physician who referred us to contact the clinical service and we were thus attempting to contact the clinical service Dr. Ramos.