 There is near diffuse effacement of the CSF space within the visualized thecal sac. There is a large dorsal epidural fluid collection with CSF signal beginning possibly as high as mid C4 vertebra extending inferiorly to the thoracolumbar junction. This measures up to 7 mm in greatest thickness, with a possible additional small ventral component along the upper thoracic spine as suggested on sagittal gradient echo images. Inferior to the thoracolumbar junction, the fluid collection becomes circumferential and occupies the ventral and dorsal epidural space. The proximal thoracic cord is displaced slightly more anteriorly within the thecal sac when compared to the prior MRI cervical spine images. Gradient echo images do not suggest any significant susceptibility within the collection to suggest blood products. A small subdural component cannot be excluded. There is moderate to severe narrowing of the thecal sac with bunching of the cauda equina distal to the level of the conus medullaris. The conus terminates at the L1 level.The lumbar spine is otherwise in normal alignment, with a normal lumbar lordosis. The vertebral body and disc heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disc bulge or herniation within the lumbar spine. No abnormal cord signal is appreciated.The bladder is moderately distended.
Extensive epidural collection at the dorsal aspect of the entire thoracic spine and surrounding the cauda equina producing moderate to severe narrowing of the distal thecal sac as well as complete effacement of CSF space along the entire thoracic cord. Possible small ventral component in the epidural space along the upper thoracic cord, with trace extension dorsally of the collection likely up to the mid C4 level. Findings are likely related to a CSF leak given the signal intensity of the fluid without definite evidence of epidural blood products. A small subdural component cannot be excluded. This collection was noted to be essentially occult on CT given its CSF density.Follow-up imaging should include the entire spine, rather than just the thoracic spine.Findings discussed with Dr. Frim by Dr. Carina Yang at the completion of the examination on 2/24/15 at 1:30 pm. 