History of kidney transplant with radicular pain down his leg status post physical therapy for several weeks but with persistent pain, evaluate. There is a grade 1 retrolisthesis of L5 on S1. Otherwise, the alignment is anatomic. At L1-L2, there is no significant spinal canal or neural foraminal stenosis. At L2-L3, there is thickening of the ligamentum flavum with facet joint hypertrophy resulting in mild right neural foraminal stenosis. At L3-L4, there is left greater than right thickening of the ligamentum flavum and hypertrophy facet joints, resulting in moderate to severe left neural foraminal narrowing and mild right neural foraminal narrowing. At L4-L5, there is protrusion of the disc into the right neural foramina along with ligamentum flavum thickening and facet joint hypertrophy, resulting in moderate to severe right neural foraminal stenosis. At L5-S1, there is a disc bulge with no significant spinal canal stenosis. However, facet joint hypertrophy and ligamentum flavum thickening result in moderate to severe right and mild left neural foraminal stenosis. There is a subcentimeter hemangioma in the S1 vertebral body. The vertebral body heights are preserved. The imaged portions of the spinal cord are unremarkable. The native kidneys are atrophic and there is a partially imaged, but large complex lesion in the right renal fossa. There is a transplanted kidney in the right iliac fossa.
1. Multilevel degenerative lumbar spondylosis, with particularly pronounced right L4-5 and L5-S1 neural foraminal narrowing and left L3-4 neural foraminal narrowing.2. Renal transplantation and bilateral renal atrophy with a partially imaged, but large complex lesions in the right renal fossa, which may represent a neoplasm. Dedicated renal imaging may be useful for further evaluation.Discussed with Dr. Jay Koyner at 11:50 AM.