Weakness [R53.1] / Malignant neoplasm of unspecified part of unspecified bronchus or lung [C34.90], Reason for Study: ^Reason: nerve root compression, bone metastasis. History: History of lung cancer presenting with left leg weakness, urinary retention Cervical Spine MRI:There is normal cervical lordosis. The cranial-cervical junction is normal. Spinal cord signal intensity is normal.Multilevel disc degenerations with disc desiccation on cervical spine including central disc protrusion at the level of C34 C4-5 and diffuse disc bulging C6-7 minimal to mild right side neural foraminal narrowing at the level of C6-7. However, there is no definitive evidence of spinal canal stenosis.There is about 24.8 mm x 29 mm sized soft tissue lesion likely representing lymph node on the right side of thyroid gland.Thoracic Spine MRI:There is about 23mm sized intramedullary lesion with diffuse enhancement at the level of T7-T8 level. There are evidence of spinal cord edema above and below the lesion with cord expansion.There is no evidence of associated syrinx.There is no evidence of hemorrhagic foci within or peripheral aspect of the lesion.Constellation of these findings suggest possible intramedullary spinal metastasis. Differential diagnosis include primary spinal cord lesion such as ependymoma. There is normal thoracic kyphosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. Lumbar Spine MRI:There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved but there are focal bone marrow edema especially anterior aspect of vertebral body at the level of the L2 and L3 which may suggest focal compression fracture without height reduction.At the level of :45 there is disc dessication, decreased disc height and central focal extrusion of disc which compresses thecal sac. In addition, associated, bilateral ligamentum flavum thickening at the level results moderate to severe spinal canal stenosis.The cord signal is normal. The conus medullaris terminates at the level of T12-L1. Again the bladder distention is shown.There is no evidence of abnormal enhancement except focal enhancement surrounding the extruded disc. No evidence of cord compression or mass.
1. Intramedullary enhancing mass at the level of T7-T8, likely represents intramedullary metastatic lesion with the differential diagnosis include spinal cord ependymoma. 2. Central disc extrusion at the level of L45 with thecal sac compression.3. No evidence of spinal cord compression.4. Multilevel various degree degenerative disc diseases as described above including cervical spine and lumbar spine level.