Male, 45 years old, with history of metastatic renal cell cancer and new thoracic spine collapse with neuropathic right chest pain. Assess for cord compression. Complete marrow replacement of the T8 vertebral body is seen with compression resulting in up to 50% loss of vertebral body height anteriorly. There may be minimal retropulsion along with nearly circumferential extraosseous enhancing tumor involvement of the ventral and lateral epidural space, resulting in moderate to severe spinal canal compromise at this level. The spinal cord is mildly deformed by this process but shows minimal if any T2 hyperintensity. The bilateral T8-9 neural foramina are also significantly narrowed secondary to extraosseous tumor spread.The T10 vertebral body is also compressed with approximately 80% loss of vertebral body height. The remaining vertebral bodies show relative preservation of height.Numerous additional marrow replacing lesions are seen throughout the thoracic spine including within T4, T7, T9, minimally at T11 and T12, and within L1. None of these additional lesions is associated with any significant epidural extension or spinal canal compromise.Spinal alignment is otherwise anatomic. Minimal degenerative disc disease is seen. Apart from findings at T8, no additional areas of significant spinal canal or neuroforaminal stenosis are seen.Multiple lung nodules are poorly visualized. Small pleural effusions are noted. A large right renal mass is also visualized.
1. Diffuse metastatic involvement of the T8 vertebral body with loss of vertebral body height and fairly extensive extraosseous tumor spread into the epidural space. This results in a moderate to severe spinal canal stenosis with deformation of the cord but minimal if any associated cord edema. The T8-9 neural foramina are also compromised by tumor spread. Discussed with Dr. Szmulewitz at 2:00 PM on 8/4/2015.2. A severe compression deformity of T10 is also seen. The remaining vertebral bodies demonstrate relatively preserved heights.3. Multiple additional sites of osseous metastatic disease are seen in the thoracic spine, but none of these is associated with any significant epidural disease spread or spinal canal stenosis.