Female, 56 years old, history of hemoglobin SC disease, complicated in the past by acute chest syndrome, with colorectal cancer status post chemoradiation and partial colectomy, now with concerns for metastatic disease. Thoracic:Pathologic marrow replacement is seen involving the spinous process and right lamina of T2 without significant epidural encroachment. A larger area of marrow replacement is seen involving the left T11 pedicle and lamina with left dorsal epidural encroachment and a mild to moderate spinal canal stenosis. The cord is displaced anteriorly and to the right, but no evidence of cord invasion or pathologic cord signal is seen.Small peripherally enhancing lesions along the superior and inferior T12 endplates are nonspecific could reflect areas of pathologic marrow replacement or developing Schmorl's node deformities.A significant dextroscoliosis of the spine is evident centered at T7. Sagittal alignment is otherwise unremarkable.Vertebral body height is preserved.Except as discussed above, no significant spinal canal stenosis is seen. Small left paracentral disc protrusions are evident at T6-7 and T7-8. A right paracentral disc protrusion is evident at T10-11. No significant foraminal stenosis is detected.Incidental note is made of small bilateral pleural effusions. Multiple healed rib fractures are suspected on the left.Lumbar:Near complete marrow replacement of the L2 vertebral body is seen with central loss of height of approximately 40%. A combination of vertebral body retropulsion and epidural disease spread results in a moderate to severe spinal canal stenosis at this level with mild crowding of the cauda equina. The L1-2 and L2-3 neural foramina on the right are mildly narrowed as well.No other definite areas of disease are seen in the lumbar spine.The lumbar spine is mildly levoscoliotic. Sagittal alignment is within normal limits.With the exception of mild disc bulging and moderate to severe facet hypertrophy at L5-S1, no significant degenerative disease is seen. Except as above, no additional high-grade spinal canal stenosis or neuroforaminal narrowing is seen.
1.Multiple sites of osseous metastatic disease are seen including the right lamina of T2, the left pedicle and lamina of T11, the L2 vertebral body, and questionably the T12 vertebral body.2.Metastatic disease results in epidural encroachment and mild to moderate spinal canal narrowing at T11; as well as compression of the L2 vertebral body with epidural encroachment and moderate to severe spinal canal stenosis.