Male 62 years old with low back pain, bilateral leg pain numbness to bottom of left foot, evaluate for new or bigger herniated disc. MRI done in March, pattern of pain has changed and increased. Unable to ambulate without pain greater than 9.Additional history from EMR: Patient is status post lung transplant, with persistent severe lower back pain. Previously described small left paracentral disc extrusion at L2-L3 appears to have resolved. There is new increased T2 signal within the L2-3 disc space with corresponding loss of disc height, now moderate in degree. There is also now ill-defined T1 hypointensity and STIR hyperintensity within the adjacent L2 and L3 vertebral bodies, with areas of cortical discontinuity suggested along the endplates. Centered on the L2-L3 level, there is increased T2 signal within the psoas muscles bilaterally with effacement and inflammatory changes of the intervening paraspinal fat, greater on the left side. The left L2-3 foraminal fat is now nearly completely effaced with heterogeneous T2 and low T1 signal of uncertain etiology, but concerning for infection. There is also moderate right neural foraminal stenosis at L2-3 due to the decreased disc height loss.There is a new prominent rounded area of increased STIR signal within the L1 vertebral body.Additional mild degenerative changes elsewhere appear similar to prior exam
1. Increased signal abnormality within the L2-3 disc space with interval loss of disc height, and surrounding marrow signal changes as well as inflammatory changes involving the adjacent left greater than right psoas muscles, concerning for discitis/osteomyelitis especially given patient's history of immunocompromise, and less likely interval degenerative changes. Further evaluation could be obtained with CT of the lumbar spine to evaluate for endplate integrity, given patient's history of renal compromise and likely inability to receive gadolinium. Alternatively, DWI o of the spine could be obtained to evaluate for a "claw sign".2. There is near complete effacement of the left L2-3 neural foramina now by abnormal signal, concerning for infectious involvement. Moderate right-sided stenosis due to the disk height loss.3. Additional new rounded STIR hyperintensity within the L1 vertebral body may represent spread of infection or less likely metastatic disease (if there is a history of a primary malignancy).4. Previously described left L2-3 paracentral disc extrusion appears to be resolved. Additional mild degenerative changes appear similar to prior exam.Findings were discussed with Dr. Choi by Dr. Comeron Ghobadi on 6/20/16 at 5:30 pm.