Diagnosis: SarcoidosisClinical question: osteomyelitisSigns and Symptoms: pain, fever, bacteremia. MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is mild loss of vertebral body height present at T7 associated with T2 signal hyperintensity within the vertebral body. Overall there is approximately 25% loss of vertebral body height. There is associated contrast enhancement adjacent to the superior endplate of a T7. Additionally there is some marrow replacement along the proximal aspect of the right T7 rib and right transverse process associated with adjacent soft tissue infiltration with soft tissue thickening and enhancement following contrast administration along the right paraspinous tissues surrounding the right T7 rib and transverse process and adjacent to the T7 vertebral body into a lesser degree T6 vertebral body and T6-7 disc space. The endplates at the T6-7 disc space are preserved. A recent CT of the chest indicates there is a proximal fracture along the right T7 rib and of the right T7 transverse process present.There is mild loss of vertebral body height at T8, T9, T10 and T11 with hyperintense signal on T1-weighted imaging but not so much on T2 STIR imaging.The patient is status post vertebroplasty at T12. The appearance of the T12 vertebral body is not changed since the 4/13/2015 examLumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact.The patient is status post vertebroplasty at T12, L1, and L3. Compared to the prior exam of 4/13/2015 there is no significant change in the vertebral body height at these levels. There is redemonstration of a compression fractures at L4 and L5. Signal changes along the superior endplate of L5 include hyperintense T2 STIR signal along the Schmorl's node associated with contrast enhancement. There is redemonstration of bone cement within the epidural venous plexus at the T12, L1 and L3.Along the anterior-inferior aspect of the L2 vertebral body there is low signal on T1 and high signal on T2 STIR associated with contrast enhancement. This measures 17 x 14 mm sagittal dimensions and was previously not present in April. The adjacent endplates are preserved.At L5-S1 there is no significant compromise to spinal canal. There is loss of disc space height and a disc bulge at this level with partial effacement of the fat surrounding the left-sided exiting nerve root within the neural foramen.At L4-5 there is mild loss of disc space height, diffuse disc bulge and bilateral facet hypertrophy and some ligamentum flavum hypertrophy the fat at the lateral recess is not effaced bilaterally. Overall there is mild spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.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.
1.Findings the are compatible with acute compression fracture of T7 associated with CT identified adjacent fractures of the proximal aspect of the right T7 rib and right T7 transverse process as well as adjacent inflammatory changes. The possibility of infection cannot be excluded but most likely this is related to reaction to the adjacent fractures. The possibility this is related sarcoid involvement cannot be excluded.2.There is an enhancing lesion present within the L2 vertebral body. This may represent an inflammatory process but is nonspecific. It was not present on the previous exam. One possibility is that this represents sarcoid involvement. The possibility of infection cannot be excluded, though has a somewhat unusual appearance.3.The patient is status post multilevel vertebroplasty.4.There is redemonstration of degenerative changes in the lower lumbar spine with mild spinal stenosis at L4-5 and some encroachment of the left exiting nerve roots at L5-S1. This is stable compared to the prior exam.5.There are multilevel compression fractures in the lumbar spine which appear relatively stable when compared to the prior exam. There is a new Schmorl's node present at L5.6.There are multilevel mild compression fractures in the lower thoracic spine from T7 to T12.