74 years Female (DOB:7/29/1942)Reason: Pt w/ CLL \T\ AML reporting 1-2 weeks of LE weakness :: Desire to r/o Cord / Nerve / Spinal pathology History: Hip weakness b/lPROVIDER/ATTENDING NAME: MICHAEL R BISHOP MICHAEL R BISHOP Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a mild dextrocurvature at the lower lumbar spine.There is an extradural infiltrative type mass present along the ventral aspect of the spinal canal behind the L5 vertebral body and the sacrum which appears to encroach on the thecal sac and exiting nerve roots at L5-S1 and within the sacral spinal canal. It is not adequately visualized on this exam due to artifact and lack of contrast enhancing study.The images are degraded due to combination of motion artifact and other artifact. There is a mottled appearance to the osseous structures patchy foci of marrow replacement suspected.At L5-S1 there is narrowing of the spinal canal due to a ventrally located extra-axial mass extending from the sacral spinal canal which is associated with compression of the thecal sac and spinal stenosis. There appears to infiltrate into the neural foramina and encroachment of exiting nerve roots. Additionally there is mild facet hypertrophy at this level.At L4-5 there is loss of disc space height and T2 signal hyperintensity within the disc associated with a disc bulge and some mild facet hypertrophy.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, loss of disc space height and disc bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.It appears that the bladder is distended but not entirely included on this exam to assess any further.
1.There appears to be a mass present within the lumbar spinal canal and sacral spinal canal extending from L5 down to S2-3. It appears infiltrate into the neural foramina and encroachment on the nerve roots within the spinal canal and neural foramina. It is not well imaged on this exam. Perhaps a contrast-enhanced MRI exam would be helpful to further delineate this and possibly identify an amenable site for percutaneous biopsy if clinically appropriate.2.There are multiple patchy foci of marrow replacement throughout the visualized sacral and lumbar spine which may be related the patient's leukemia.3.There are degenerative changes present in the lower lumbar spine associated with a dextrocurvature to the lower lumbar spine4.The urinary bladder appears to be markedly distended. No obstructing lesion cannot be excluded5.Examination is degraded due to patient motion which will obscure more subtle abnormalities.6.Findings were discussed with Dr. Bishop at the time of this interpretation.