Diagnosis: Low back pain Paresthesia of skinClinical question: evaluate for disc herniationSigns and Symptoms: low back pain, not improved with conservative 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. There is a mild degree of diffuse marrow replacement present. On T1-weighted imaging there is a high signal focus present within the L1 vertebral body measuring 13 x 10 mm sagittal dimensions which is bright on T1 and suppresses partially on the STIR images. This most likely represents a vertebral body hemangioma.Within the cutaneous tissues superficially there is a cystic appearing lesion present measuring approximately 14 x 10 mm axial dimensions which extends to the surface of the skin. It should be visible on physical exam and is midline in location at approximately the L4 vertebral body level. Most likely represents a sebaceous cyst.At L5-S1 there is no significant compromise to spinal canal . There is loss of disc space heights disc desiccation and endplate reactive change present at this level. There is irregularity along the endplates. The endplate reactive changes are high signal on T1. There is associated diffuse disc bulge at this level and mild ligamentum flavum and facet hypertrophy. The fat surrounding the exiting nerve roots within the neural foramina is effaced bilaterally. There is bilateral encroachment of exiting nerve roots within the neural foramina at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a moderate degree of facet hypertrophy present at this level. There is a mild disc bulge present 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.There are multiple cysts present along the kidneys the largest one in the right kidney measures 36 x 43 mm axial dimensions and is not completely included on this exam. There are a couple smaller cysts present along the inferior pole of the right kidney and to a lesser degree than smaller cysts in the left kidney. Some of these can be seen on a CT of the chest from 2012.
1.There are degenerative changes present in the lumbar spine which are worse at L5-S1 where there is encroachment of the exiting nerve roots within the neural foramina bilaterally due to degenerative changes.2.Multiple renal cysts.3.There is a mild degree of diffuse marrow replacement present which is a nonspecific finding. This can be seen with chronic disease, anemia, lymphoproliferative disorders. It is nonspecific. In isolation it is of little clinical significance