Reason: eval for structural lesions History: paraparetic, urine retention Thoracic spine: Redemonstration edema of the C6/7 disc space with asymmetric anterior widening and suggestion of anterior longitudinal ligament disruption. Cervical prevertebral edema again noted. Exaggerated thoracic kyphosis noted. Bone marrow signal is benign. Vertebral body heights are maintained. Diffuse thoracic disc desiccation and mild mid thoracic disc height loss. There is rightward thoracic curvature. Thoracic spinal cord has a smooth contour and is without focal atrophy, edema, myelomalacia. No spinal canal hematoma, mass, or mass effect. There is dorsal and right epidural lipomatosis which pushes the thecal sac towards the left and ventrally within the bony canal but without deformity or effacement of the thecal sac. There is focal fat or hemangioma of the T4, T6, and T9 vertebral bodies.C7/T1: Mild uncovering of the disc from minimal grade 1 retrolisthesis of C7 over T1. No significant spinal canal stenosis or neural foraminal narrowing.T1/2: No significant spinal canal stenosis. Facet arthropathy with moderate bilateral foraminal narrowing.T2/3: No significant spinal canal stenosis or foraminal narrowing.T3/4: No significant spinal canal stenosis or foraminal narrowing.T4/5: No significant spinal canal stenosis. Ligamentum flavum thickening, left greater than right with moderate right foraminal narrowing.T5/6: No significant spinal canal stenosis or foraminal narrowing.T6/7: No significant spinal canal stenosis or foraminal narrowing.T7/8: No significant spinal canal stenosis or foraminal narrowing.T8/9: Tiny central disc protrusion without significant spinal canal stenosis. Ligamentum flavum thickening with mild right neuroforaminal narrowing.T9/10: No significant spinal canal stenosis. Facet joint arthropathy with moderate left and mild right neural foraminal narrowing.T10/11: No significant spinal canal stenosis. Facet joint arthropathy, left greater than right. Moderate left greater than right foraminal narrowing.T11/12: Ligamentum flavum hypertrophy particularly on the left, with mild spinal canal narrowing. Moderate bilateral foraminal narrowing.T12/L1: Left facet arthropathy with mild spinal canal narrowing. No significant foraminal narrowing.Lumbar spine: Alignment is anatomic. There are no subluxations. There is Schmorl's node with degenerative marrow changes at L2-3 and L3-4 levels. Degenerative marrow changes also at L5-S1 level. The conus is normal in signal and morphology and terminates at an appropriate level. No intraspinal hematoma, mass, or mass effect. Redundant and thickened cauda equina roots. There is leftward lumbar curvature.There is 1.6 cm rounded filling defect in the gallbladder, likely gallstone.Multiple bilateral large T2 hyperintense cystic structures in the kidneys, incompletely characterized. Gross comparison to 2006 CT exam shows interval growth. Variant anatomy of the psoas musculature with accessory muscle on the left, posteriorly. There is ill-defined T2 hyperintensity in this accessory muscle, as well as in portions of visualized bilateral iliacus muscles. There are a few rounded and irregular heterogeneous lesions with rim of T2 hypointensity in this accessory muscle and right iliacus, which may be mineralization associated with old blood products or prior abscesses. CT may be performed to confirm this but in the absence of patient symptoms, these findings are of questionable clinical significance. L1/2: Mild posterior disc bulge. Bilateral facet joint arthropathy with ligamentum flavum thickening resulting in moderate spinal canal stenosis. There is mild to moderate right and moderate left foraminal narrowing. L2/3: Mild to moderate disc bulge posteriorly. Facet joints arthropathy with ligamentum flavum thickening, left greater than right, with moderate bilateral foraminal narrowing and severe spinal canal stenosis.L3/4: T1 and T2 hypointense disc, suggestive of mineralization and vacuum phenomenon. Mild disc bulge posteriorly. Facet joint arthropathy with ligamentum flavum thickening resulting in moderate spinal canal stenosis. There is bilateral mild neural foraminal narrowing. L4/5: Right ligament flavum is not well-visualized, correlate with possible prior surgery versus developmental finding. There is right far lateral bridging osteophyte resulting in a mild right foraminal narrowing. No significant spinal canal stenosis.L5/S1: Mild to moderate posterior disc bulge slightly right sided without significant spinal canal stenosis. Bilateral facet joint arthropathy with bilateral moderate foraminal narrowing.
1.Multilevel degenerative disc disease as above, with up to severe central spinal canal stenosis at L2-3. 2.Midthoracic eccentric epidural lipomatosis.3.Variant anatomy of the left psoas musculature, with findings suggestive of possible myositis ossificans, also affecting the right and possibly left iliacus muscles, of questionable clinical significance. CT could be obtained as clinically indicated.4.Interval 1.6 cm gallbladder filling defect consistent with cholelithiasis. Ultrasound may be obtained for further evaluation if clinical symptoms.5.Multiple bilateral large T2 hyperintense cystic structures, which appear increased in size from 2006 CT exam. These lesions are incompletely evaluated. Ultrasound may performed for further evaluation if clinically indicated.