 Thoracic spine: There are multiple osseous lesions compatible with metastatic disease with associated epidural extension. There is enhancing soft tissue epidural extension at T1, T4, and T6. There is greater than 50% loss of vertebral body height with retropulsion of approximately 4 mm at T4, which abuts the spinal cord, but there is no actual spinal cord compression. There is exaggerated kyphosis centered at the T4 level. The disc heights are well maintained. The spinal cord is of normal signal. Numerous lesions are also present in several ribs bilaterally, which are compatible with metastatic disease. There is a partially imaged left pleural effusion.Lumbar spine: There are numerous foci of abnormal bone marrow signal and enhancement throughout the lumbar spine compatible with metastatic disease. There has been further height loss of the L4 vertebral body to approximately 75% loss, which also demonstrates abnormal bone marrow signal. There is worsening of retropulsion/soft tissue extension. Combined with degenerative ligamentum flavum thickening, there is resultant severe spinal canal stenosis at this level. Vertebroplasty changes are present in the L1 vertebra. The distal spinal cord and conus medullaris are within normal limits. There is diffuse disc desiccation signal and loss of intervertebral disc height throughout the lumbar spine. There are disc bulges at T12-L1, L2-L3, L3-L4, L4-5, and multilevel bilateral ligamentum flavum thickening causing multilevel spinal canal stenosis up to a moderate degree at L4-L5. Multiple lesions are present in the sacrum and bilateral iliac bones, which are also compatible with metastatic disease.
1. Diffuse metastases to the axial skeleton, including a pathologic T4 compression fracture without spinal cord compression and interval progression of a pathologic L4 compression fracture with persistent severe spinal canal stenosis at this level. 2. Multilevel degenerative spondylosis in the lumbar spine.3. Partially imaged left pleural effusion.