 Images are limited by patient motion especially on axial images and lack of contrast. Extensive postoperative changes are again seen from previous T8-T12 fusion and T10 corpectomy. This results in susceptibility artifact which limits evaluation of surrounding structures.Within these limitations, there is extensive T2/STIR hyperintense fluid signal along the superficial aspect of the surgical bed and posterior aspect of the indwelling instrumentation. This fluid collection measures approximately 8.9 cm transverse x 4.0 cm AP by likely 10.5 cm CC, and appears to abut the dura at the level of the corpectomy where there is less obscuration by artifact. The collection extends from the T8 level down to T12, with a small eccentric component extending more superficially into the left paramedian subcutaneous fat. A few foci of internal susceptibility are seen, which may represent air. The more superficial collection is only partially visualized but measures at least 11.7 cm CC, x 3.0 cm transverse x 3.2 cm AP, identified T7 level down to the T12 level. The paravertebral mass centered at the T9-T10 levels has increased in size. It now measures 8.6 cm transverse by 7.2 cm AP by approximately 5.8 cm CC. Previous MRI suggested measurements of 3.3 cm AP x 4.0 cm CC, while the more recent CT of the abdomen demonstrated a 7.2 cm transverse x 5.6 cm AP mass.The thoracic spine is in normal alignment, with a normal thoracic kyphosis. Scattered multilevel disc narrowing and desiccation is noted. Diffuse low T1 marrow signal and STIR hyperintensity is again seen involving the T5 vertebral body consistent with metastatic disease with interval further mild compression deformity. There has also been interval progression of a smaller metastatic lesion along the right lateral aspect of the T1 vertebral body. There is a stable focal T2 and T1 hyperintense lesion in the T6 vertebral body which is consistent with an area of focal fat. Cord signal cannot be adequately assessed secondary to extensive motion artifact on axial images and probable susceptibility artifact on the sagittal images, although there is questioned mild STIR hyperintensity within the cord spanning the T7 level.There is a small right-sided pleural effusion. An oval area of STIR hyperintensity is noted additionally along the manubrium, representing additional metastatic disease.
1. Extensive persistent nonspecific fluid collection identified spanning the levels of surgery with asymmetric involvement more superficially to the left of midline. This appears to at least abut the dura at the level of previous corpectomy at T10 where there is less obscuration by metallic susceptibility artifact. This may represent a persistent seroma, although the possibility of superinfection is not excluded. Please correlate clinically.2. Mild interval further pathologic compression deformity of the T5 vertebral body, with additional metastatic lesion in the T1 vertebral body which appears mildly progressed as well.3. Significant progression of perivertebral soft tissue component of metastatic disease spanning the T9 and T10 levels. Cord signal and degree of spinal canal stenosis at these levels is difficult to assess secondary to the extensive artifact.4. Partially evaluated manubrial metastasis.