 There is a near contiguous intermediate T1 and high T2 signal intensity material, when compared to the paraspinal musculature, which diffusely and avidly enhances within the anterior epidural space, the neural foramina, and prevertebral spaces extending from the inferior aspect of C4 to the T6/T7 level. Along the upper spine, this appears to be centered at the C7 level where there is mild lordosis of the cervicothoracic junction and edema type signal within the posterior elements of C7, as well as scattered elsewhere throughout the cervical and thoracic vertebrae.This process effaces/invades the bilateral neural foramina from C4 to C7, the right neural foramina from T1-T7/T9, the left neural foramina from T1 to T10/11. There is moderate spinal canal stenosis at the cervicothoracic junction and scattered mild stenosis of the upper to mid thoracic spinal canal. There are more focal regions of heterogeneity within this material at C7/T1 extending into the right T1/T2 neural foramina and within the epidural space of T5 extending into the left neural foramina of T5/T6, without defined collections measurable. There is no abnormal signal abnormality within the cord. Furthermore, the right cervical vessels are displaced anteriorly from mass effect. The vertebral arteries, right greater than left, are also encased, however, flow voids appear preserved. There is a near continuous peripherally enhancing, central low intensity collection in the prevertebral soft tissues extending from the level of T1 to T11/T12 with loculated/complex components in areas. The collection at its maximal thickness measures 10 mm along the right anterior aspect of the T6/T7 vertebral bodies. There is low T1 signal intensity within the C4-T1 vertebral bodies and posterior elements of C7 with associated abnormal T2 signal and enhancement which is more prominent within the vertebral bodies of C4 and C5 and the spinous process of C7. There is additional patchy low T1 signal, high T2 signal, and enhancement within the posterior aspect of the T2-T7 vertebral bodies and throughout the T8-T11 vertebral bodies. There is no significant signal abnormality within the interposed disc spaces of the cervical or thoracic spine. There is irregular opacity within the posterior right upper lobe as well as focal pleural thickening and enhancement medially, adjacent to the paraspinal inflammatory change. Fluid is noted within the esophagus.
1. Extensive enhancing paravertebral and epidural material extending from the C4 to T6/T7 which appears to be centered at the level of C7 along the upper spine, with isolated signal abnormality within the posterior elements at this level and a loculated prevertebral peripherally enhancing collection extending from T1 to T12. Epidural material nearly completes effaces the neural foramina of the mid cervical spine to the lower thoracic spine and there is scattered up to moderate central spinal canal stenosis without intrinsic cord signal abnormality. There is also bone marrow signal abnormality within the mid cervical to lower thoracic vertebral bodies without evidence of disk abnormality. Given the patient's history, the differential diagnosis primarily includes TB spondylitis with abscess formation, although atypical infectious or fungal etiologies are possible. Lymphoma or metastatic disease are also a consideration.2. Posterior right upper lobe nonspecific irregular opacity with adjacent pleural thickening, incompletely evaluated; dedicated chest radiograph is recommended for further evaluation, especially with the consideration for possible TB involvement. Findings communicated via telephone to Nathan Frogge at 1117 hrs on 1/27/2016.