51 years Female (DOB: 12/7/1964)Reason: Evaluate for metastases, known metastatic synovial sarcoma with known spinal lesion at T4. History: LE paresthesiaPROVIDER NAME: HARVEY M GOLOMB HARVEY M GOLOMB MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. One located in the left frontal lobe subcortical white matter is associated with an adjacent punctate focus of signal loss on susceptibility imagingNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:There is a 21 x 10 mm sagittal dimension mass centered in the thoracic spinal cord at the T4-5 disc space level. It appears to be intra-axial with an exophytic component. There is associated T2 signal hyperintensity within the spinal cord extending up to the T2 vertebral body level and down to the T5-6 disc space level. It is well-circumscribed. It is slightly hyperintense to the spinal cord on T1-weighted imaging and hyperintense relative to the spinal cord at T2-weighted imaging.There is an airspace opacity present along the right upper lobe associated with streak-like opacities. It measures approximately 12 mm in size.There is right-sided pleural thickening present associated with loss of volume in the right chest cavity indication of prior chest surgery.There is a T1 hyperintense lesion measuring 10 mm located within the T1 vertebral body which suppresses on the fat suppressed images and most likely represents a hemangioma.The thoracic vertebral bodies are appropriate in the overall alignment and height. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is a right lateral recess disc protrusion present which mildly impresses on the nerve roots of the right lateral recess and effaces the fat ventral and posterior to the nerve roots of the right lateral recess.At L4-5 there is some loss of disc space height, disc desiccation mild disc bulge and some mild ligamentum flavum hypertrophy. There is no significant compromise to the spinal canal or exiting nerve roots at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.There is a mass centered in the thoracic spinal cord at the T4-5 disc space level associated with some adjacent edema in the spinal cord. This is suspicious for neoplasm which could either be primary or secondary.2.There is a 12 mm right upper lobe lung lesion suspicious for round atelectasis. Please refer to CT scan of the same date for further comments.3.The patient is status post right lung surgery. 4.There is right-sided pleural thickening present. Please refer to CT scan of the same date for further comments.5.There is some mild degenerative change in the lower lumbar spine with some mild encroachment of the nerve roots of the right lateral recess at L5-S1 due to a disc protrusion