Newly diagnosed breast cancer. Hepatic lesions suspicious for metastatic disease. Back pain but neurologically nonfocal. There are 7 cervical, 12 thoracic, 4 lumbar, and 1 lumbosacral transitional vertebra. This transitional vertebra is labeled L5 for the purposes of this dictation.There is normal curvature and alignment of the spine. There is no fracture or loss of height of the vertebra. However, there is hypodensity within the right C3 vertebra and the left C5 vertebra (series 8051 images 16 and 20 respectively). Also question of focal lesion within right T1 vertebra (series 8050 image 19). These lesions are nonspecific and enhancement pattern cannot be accurately characterized by CT. However, they could represent metastatic disease in this patient who has breast cancer newly diagnosed. Bone scan may be helpful for confirming active bone remodelling and detecting occult lesions elsewhere.Detection of intracanalicular and paravertebral metastatic disease is extremely difficult based on CT. However, there is no gross intracanalicular mass lesion that can be identified based on CT. The morphology of the cord and conus medullaris appear grossly normal. In this circumstance, clinical correlation is essential.Moderate cervical spine degenerative change is present. Findings are specified level by level:C2-C3: No disk herniation, thecal sac effacement, or foraminal narrowing.C3-C4: Left sided disk osteophyte complex and uncovertebral hypertrophy. As a result, there is mild narrowing of the ventral thecal sac on the left and moderate left foraminal narrowing.C4-C5: Questionable disk protrusion with at most partial ventral thecal sac effacement. Minimal foraminal narrowing secondary to uncovertebral hypertrophy and facet hypertrophy. There is acquired fusion of the right facet articulation at this level.C5-C6: Posterior disk osteophyte complex results in partial sac effacement. There is also severe right and minimal left foraminal narrowing secondary to uncovertebral hypertrophy and facet hypertrophy.C6-C7: Minimal posterior disk osteophyte complex with at most partial ventral thecal sac effacement. Mild bilateral foraminal narrowing secondary to uncovertebral hypertrophy.C7-T1: No gross disk herniation, thecal sac effacement, or foraminal narrowing. However, streak artifact obscures detail at this level.In the thoracic spine, there is no gross disk herniation or thecal sac effacement apart from some mild dorsal thecal sac partial effacement at right T8-T9 and T10-T11 from calcified ligamentum flavum hypertrophy. There is no osseous encroachment upon the neural foramina though small disk herniations could be easily obscured given image quality. There is endplate sclerosis and anterior osteophyte seen between T3 and T12.In the lumbar spine, there is minimal degenerative change. Findings are specified level by level:L1-L2: No disk herniation, thecal sac effacement, or convincing foraminal encroachment.L2-L3: Minimal diffuse disk bulge. No central canal stenosis or foraminal narrowing.L3-L4: Mild diffuse disk bulge eccentric to the left. While there is no central canal stenosis, there is mild to moderate left foraminal narrowing from the disk herniation. Also minimal facet hypertrophy.L4-L5: Mild diffuse disk bulge with some questionable encroachment on the lateral recesses. No central canal stenosis. Probably some mild foraminal narrowing bilaterally.L5-S1: Partially fused disk space. No disk herniation, central canal stenosis, or foraminal narrowing.In the extraspinal soft tissue structures, there is elevation of the right hypopharynx from retropharyngeal carotid. No cervical lymph nodes. There is a right pleural effusion with passive atelectasis and a calcified subcarinal lymph nodes and right hilar lymph nodes, better evaluated on earlier chest CT. The nodularity of the liver is not well demonstrated on this examination which is motion degraded and has a more circumscribed field-of-view; hepatomegaly still evident. Slice intracranial contents are unremarkable apart from some mild intracranial vasculature ossification. Hypodensity seen in the middle cerebellar peduncles is felt to be most likely artifactual.
1. Areas of hypodensity/bone lysis within the right C3 and possibly left C5, right T1 vertebra. At least the C3 lesion is suspicious for metastatic disease--correlative bone scan (nuclear medicine) may be of value. No other destructive osseous lesions and no compression fractures.2. This study is poorly sensitive for intracanalicular metastatic disease and paravertebrally metastatic disease. However, no gross compression of the cord or conus is seen. If there is strong concern for leptomeningeal disease, suggest CSF puncture. 3. Mild to moderate spinal degenerative changes. Small and subtle findings are potentially obscured given poor image quality.4. Chest and abdominal findings were better seen on prior dedicated imaging. Slightly increased right pleural effusion.Findings discussed with and acknowledged by Dr. Laffin 10/27/2012 11:38 AM .