Reason: 59M with metastatic melanoma, please assess for new lumbar mets to explain right leg weakness and pain History: right leg weakness and pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. Multiple marrow replacing lesions present throughout the visualized portions of the thoracic spine and sacrum and also throughout the lumbar spine. These were also present on the prior exam. There are associated compression fractures at L4 and T11 which are stable when compared to the prior exam. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet and ligamentum flavum hypertrophy at this level, loss of disk space height, disk desiccation, diffuse disk bulge, endplate osteophytes and endplate reactive changes with associated narrowing of the neural foramina bilaterally.At L4-5 there is a mass extending from the right half of the L4 through body and to the right paravertebral space as well as the epidural space and the right neural foramen. This results in narrowing of the spinal canal and encroachment of the thecal sac with spinal stenosis as well as encroachment of the exiting nerve roots the neural foramina. This appearance is not substantially changed since the previous exam. There is also facet ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is facet and ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a large Schmorl's node present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is mild compression of the T11 vertebral body and some narrowing of the spinal canal at the T10-T11 level.There is a large parapelvic cyst in the right kidney which is unchanged since the prior exam.There is right pelvic retroperitoneal mass present which is not entirely included on this exam.
1.There is redemonstration and no significant change in diffuse skeletal metastases to the spine associated with extraosseous extension at the L4 vertebral level resulting in spinal stenosis and right-sided neural foramen encroachment of exiting nerve roots. 2.There are some compression fractures present at L4 and T11 which are stable since prior exam.3.Large pelvic mass appeared please referred to PET CT for further comments. This appears to involve the expected location of the right lumbosacral plexus.4.Large right-sided renal cyst