Metastasis to spine from prostate cancer. Presented with new bilateral leg numbness and weakness of 4 days duration. A limited examination with only sagittal T1 and STIR sequences was obtained through the spine to rule out spinal cord compression. There are postoperative findings related to previous decompressive T5-T7 laminectomies. The abnormal marrow signal in T5-T8 has progressed and is associated with new 50% anterior compression fracture of T7 vertebral body. There is also increased extraosseous, paraspinal soft tissue component that involves also the laminectomy site and causes increased deformity and signal abnormality of the spinal cord. Apparent central T2-hyperintense signal throughout the length of the spinal cord may represent artifact versus a presyrinx. There is also soft tissue infiltration into the left T5-T9 and the right T6-T7 neural foramina. A lesion in T9 vertebral body has increased in size, but there is no associated pathologic fracture. The extensive abnormal signal without significant expansion involving the T1, L1, and L5 vertebrae and sacrum has not significantly changed and is not associated with spinal canal stenosis. The mild, predominantly right-sided posterior/central L5 vertebral body compression has not changed. Degenerative spinal canal narrowing at C4-C5 and C5-C6 may have minimally increased since December 2015, mildly indenting the spinal cord. The clival metastasis is only partially imaged. A large left pleural effusion and superior mediastinal and retroperitoneal lymphadenopathy are also only partly imaged.
1.Progressed metastatic involvement of T5-T8 with increased extraosseous soft tissue component and spinal cord compression. 2.New anterior T7 vertebral body compression fracture.3.A lesion in the T9 vertebral body has progressed. Otherwise, lesions T1, L1, and L5 vertebrae and sacrum have not significantly changed and are not associated with spinal canal stenosis.4.The clival metastasis, left pleural effusion, and mediastinal and retroperitoneal lymphadenopathy are only partially imaged.On-call radiology resident Dr. Sujay Sheth discussed the above findings with the ER staff (Jen) over the phone on January 22, 2016 at 2150 hours.