59 year old female with a bacteremia and metastatic breast lesions to the spine. Evaluate for discitis/osteomyelitis. There is transitional lumbosacral anatomy with 6 lumbar appearing vertebrae. For the purposes of this exam, the last fully formed disc is at L6-S1. The last rib-bearing vertebra is designated as T12. Please note that this differs from the previous counting convention from the CT lumbar spine 7/1/2015.There are diffuse osseous metastases involving the visualized vertebrae with similar pattern to previous. Again seen is a mild overall compression deformity of L3 due to associated metastatic disease with a focal concavity along the inferior endplate. A focal concave metastatic lesion along the inferior plate of L4 also appears similar to prior exam.The spinal cord has grossly normal signal characteristics and overall morphology. There is no compromise of the spinal cord. There is slight reversal of the cervical lordosis with associated degenerative changes most prominently involving the C5-6 and C6-7 levels. There is retropulsion of fracture fragments at L3-L4 along with minimal disc disease without high-grade central spinal canal stenosis. There is prominent pre-vertebral fluid signal, measuring up to 12 mm in greatest thickness at the lower C4 level with loss of the fat plane involving the posterior pharyngeal region. Again demonstrated is a partially visualized presumed enlarged fibroid uterus. Correlate with the recent CT abdomen and pelvis.
1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2.No evidence of discitis/osteomyelitis.3.Prominent prevertebral fluid signal along the cervical spine with loss of the intervening fat plane with the pharynx, which can be evaluated further with a neck CT if there is clinical concern for infection in this region.4.Transitional lumbosacral anatomy as detailed above, which differs from previous counting convention. If surgery is being contemplated, recommend correlation with imaging of the entire spine.5.Diffuse osseous metastases involving the spine and evidence of persistent concavity of the inferior endplates of L3 and L4 relating to metastatic lesions/compression deformity.6.Partially visualized presumed enlarged fibroid uterus. Correlate with the recent CT abdomen and pelvis.Findings were discussed with Dr. Kiraly (Pager 3655) at approximately 12:30 pm on 7/2/2016 by Dr. Veronesi of the Radiology service.