Thoracic or lumbosacral neuritis or radiculitis, unspecifiedClinical question: hematoma, nerve compression, abscess. Signs and Symptoms: 55 yo male with history of metastatic cancer w/ bony mets s/p laminoforaminotomy presenting with R leg pain and weakness There is redemonstration of the multiple marrow replacing lesions throughout the visualized lumbar spine, lower thoracic spine sacrum and pelvis. Some of these extend beyond the cortex of the bone. There is some patchy enhancement associated with these lesions. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There is mild loss of vertebral body height at L4. The conus medullaris on sagittal imaging is grossly intact. There is a heterogeneous signal intensity fluid collection present at the surgical site at the L3-4 level which impresses on the thecal sac from posteriorly. It extends between the spinous processes and measures 26 x 23 mm sagittal dimensions and 21 x 5 mm axial dimensions.The patient is status post laminotomies at the L3-4 level.At L5-S1 there is a diffuse disc bulge present associated with effacement of the fat at the lateral recesses bilaterally and encroachment of the nerve roots at the lateral recesses. The exiting nerve roots within the neural foramina are surrounded by fat. Overall there is moderate spinal stenosis at this level. These findings were also present in the April examinationAt L4-5 there is loss of disc space height, diffuse disc bulge and mild ligamentum flavum hypertrophy associated with effacement of fat at the lateral recesses bilaterally and crowding of the nerve roots within the thecal sac leading to spinal stenosis. Additionally the posterior aspect of the L4 vertebral body bulges into the spinal canal and narrows the thecal sac leading to spinal stenosis. At L3-4 there is diffuse disc bulge associated with facet hypertrophy and effacement of the spinal fluid within the thecal sac and crowding of the nerve roots. There is a mild degree of facet and ligamentum flavum hypertrophy at this level. Behind the L3 vertebral body there is a ventral fluid collection measuring 35 x 6 mm AP dimension and 11 x 6 mm axial dimension the cauda equina is crowded behind this ventrally oriented fluid collection within the thecal sac. There is a fluid collection present at the surgical site at the L3-4 level which impresses on the thecal sac from posteriorly.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild facet and ligamentum flavum hypertrophy at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.There is a right sided renal cystic lesion present measuring 10 x 11 mm axial dimensions.
1.There is spinal stenosis at L5-S1 predominantly related to degenerative changes.2.There is spinal stenosis at L4-5 and at the L4 vertebral body level related to bulging of the vertebral body posteriorly from the neoplasm and to some degree degenerative change.3.There is spinal stenosis present at L3-4 related to degenerative changes, a small postoperative complex fluid collection as well as what appears to be an arachnoid cyst on the ventral aspect of the thecal sac. The complex fluid collection is a nonspecific. Differential considerations do include blood products and early abscess formation.4.There are multiple marrow replacing lesions throughout the visualized bony structures compatible with patient's known metastatic disease. There is a mild compression fracture at L4.