History of laryngeal carcinoma, now with progressive low back pain. There is generalized osteopenia. At the inferior endplate of L2, there is a lytic lesion, with bone erosion and concave depression of the endplate into the L2 vertebra. There is mild soft tissue thickening in the paraspinal region. There is also lucent lesion involving posterior aspect of the S1 vertebra, with subtle cortical disruption. These lesions are suspicious for metastatic bone disease. There are additional lucent lesions scattered throughout the rest of the lumbosacral spine, which can also potentially represent metastatic disease. Further correlation with MRI of the lumbar spine is recommended.There is a sclerotic focus in the left ilium, which is nonspecific, but is compatible with a bone island. Degenerative disease is seen throughout the lumbosacral spine, resulting in spinal canal and neural foraminal narrowing. Disk bulging / protrusion and degenerative changes of the posterior elements are seen at L1 -- L2 to L5 -- S1 levels. The spinal canal stenosis is worst at L3 -- L4 and L4 -- L5 levels. Neuroforaminal narrowing is visualized at all levels, worst at L4 -- L5 levels, with likely impingement of the exiting nerve on the right.There is enlargement of the prostate gland and thickening of the bladder wall. Aorto-femoral stents are noted.
1. Lytic lesions at L2 and S1 with bone erosion, suspicious for metastatic disease. Further evaluation with MRI without and with contrast is recommended.2. Degenerative disease of the lumbar spine as described above, with spinal canal and neuroforaminal stenosis. 3. Please also refer to CT pelvis for additional findings.