Male, 73 years old, history of metastatic melanoma with new metastatic lesion at T7 on recent CT. A bulky tumor deposit is evident centered on the proximal right T2 rib measuring up to 59 x 35 mm in the axial plane. This lesion encases the proximal rib with extension into the right hemithorax and also into the right posterior paraspinal musculature. Furthermore, this lesion involves the right aspect of the T2 vertebral body, and extends into the right lateral epidural space. The spinal canal is mildly narrowed and the spinal cord is mildly displaced towards the left but not frankly impinged. There is no convincing evidence of any abnormal cord signal intensity. The right T1-2 and T2-3 neural foramina are encroached upon by tumor.A metastatic deposit is present within the left aspect of the T4 vertebral body. This results in mild osseous expansion and very slight tumor invasion of the left ventral epidural space. There is no significant spinal canal stenosis, cord impingement or cord signal abnormality seen. The neural foramina remain patent at this level.A metastatic deposit within the right posterior aspect of the T7 vertebral body is seen. This lesion also results in very mild encroachment upon the right ventral thecal sac with mild displacement of the spinal cord but no significant stenosis or cord impingement and no evidence of cord signal abnormality.Small lesions are suspected within the T9 and T10 vertebral bodies without epidural disease extension.The T11 vertebral body shows diffuse marrow replacement and pathologic enhancement compatible with metastatic involvement. No epidural disease extension is seen at this level. However, there does appear to be tumor extending from the marrow space into the retrocrural space just anterior to the vertebral body.Bulky left hilar tumor is demonstrated. Small pleural effusions are present. Bulky hepatic metastases are partially visualized.Spinal alignment is grossly anatomic. Vertebral body heights are also grossly preserved. Mild degenerative findings are seen throughout the thoracic spine without significant resulting spinal canal stenosis.
1.Bulky tumor is present centered on the proximal right T2 rib. This lesion involves the right aspect of the T2 vertebral body and extends into the right lateral epidural space. The spinal canal is mildly narrowed and the spinal cord is displaced towards the left. No evidence of cord impingement or cord edema is seen. The right T1-2 and T2-3 neural foramina are narrowed by tumor.2.Metastatic disease within the T4 vertebral body results in very mild encroachment upon the left ventral epidural space without significant canal stenosis or cord impingement.3.Diffuse tumor involvement of the T11 vertebral body. Tumor extends into the retrocrural space just anterior to the vertebral body, but no epidural disease involvement is seen at this level.4.Small metastatic deposits are evident at additional levels as above.5.Left hilar and hepatic tumors are partially visualized.