History of cervicothoracic laminectomy for tumor resection. Evaluate for infection. There are postsurgical changes of laminectomy from C7 to T2 and resection of previously seen intramedullary hemorrhagic lesion. Prior postoperative MRI was of the thoracic spine and in comparison with the limited view of the cervical spine on the sagittal sequence, there is interval development of a fluid collection in the paraspinous soft tissues at the C4-C5 to mid T1 level and a second component from which extends inferiorly to the T3 level which is in continuity. Total fluid collection measures approximately 5.8 x 5.7 x 8.1 cm in the AP, transverse, and craniocaudal dimensions. There are fluid-fluid levels. Fluid collection demonstrates predominantly low T1 signal with some areas of T1 hyperintensity and T2 hyperintensity indicative of at least some component of blood products.Fluid collection mostly involves the subcutaneous soft tissues with a smaller component extending into the paraspinous soft tissues and tracking along the surgical incision site into the extrathecal space from C6 to the upper T2 level. There is anterior displacement of the cervical cord. Examination is slightly motion degraded. There is T2 hyperintensity within the cord associated with the resection cavity. No new cord edema is appreciated. Vertebral body heights and alignment are maintained. No evidence of diskitis osteomyelitis. There is mild thin enhancement surrounding the fluid collection with relatively greater enhancement involving the paraspinous soft tissues.
1. Comparison with prior postoperative thoracic spine study is slightly limited. There is however interval development of a large fluid collection measuring 5.8 x 5.7 x 8.1 cm with fluid levels primarily involving the subcutaneous soft tissues with extension into the paraspinous soft tissues and a small component within the spinal canal. Signal intensity is indicative of at least some blood products. Fluid collection extends from the C4-C5 to the T3-T4 levels. There is a fluid-fluid level which may be related to hematocrit effect and raises possibility of active bleeding. There is some enhancement surrounding the paraspinous soft tissues which may be postsurgical. Overall signal features are not consistent with simple pseudomeningocele although some of the fluid may be CSF admixed with blood products. Mild enhancement in the surgical bed may be postsurgical; superimposed infection cannot entirely be excluded and aspiration can be considered as clinically warranted.2. Mild mass-effect on the upper thoracic cord which is anteriorly displaced. There is some T2 hyperintensity within the cord which was seen on prior and may be related to the resection cavity. No definitive evidence of new cord edema.Dr. Ali discussed findings with Dr. Lesniak at 945 hrs on 2/25/2015. 