69 years Female (DOB:12/22/1946)Reason: metastatic breast cancer History: complaints of stiffness/soreness in neck and armPROVIDER/ATTENDING NAME: RITA NANDA RITA NANDA There is a severe compression fracture present T1 with associated subluxation at C7-T1. This compression fracture is new since the prior exam. There is previously a marrow replacing mass at this level. There are marrow replacing lesions identified within the thoracic spine. One at T2 measures 18 x 12 mm axial dimensions and previously measured significantly smaller. Another one is present at T4 which extends through the left pedicle of T4 and measures approximately 32 mm AP dimension on sagittal imaging and 14 mm in height. There is a mild superior endplate compression of T4 present.There are marrow replacing lesions present along the spinous processes of C5 and C6 as well as the spinous process of T1. These are associated with contrast enhancement.The cervical spinal cord has normal signal characteristics and overall morphology. 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. There is a disc bulge present this level.At C5-6 there is loss of disc space height, disc desiccation, disc bulge, endplate and uncovertebral osteophytes as well as hypertrophy ligamentum flavum resulting in effacement of spinal fluid ventral and posterior the spinal cord and overall a moderate degree of spinal stenosis. This is spinal stenosis was not readily evident on the prior exam however it may be exaggerated in this exam due to extended position of the patient's neck.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is anterior subluxation of C7 on T1 associated with T1 compression fracture and there is some effacement of spinal fluid ventral and posterior the spinal cord at this level. There is encroachment of the exiting nerve roots within the neural foramina at T1-T2. The vertebral artery flow voids appear to be intact.
1.Since the prior examination the patient has developed a severe compression fracture at T1 associated with subluxation and narrowing of the spinal canal. This is most likely related to malignant compression fracture.2.There is a mild compression fracture present at T4. This is also likely a malignant compression fracture3.There are multiple marrow replacing lesions present at C5, C6, T1, T2 and T4 which are compatible with metastatic disease. This appears to have progressed compared to the prior exam.4.There is a moderate degree of spinal stenosis present at C5-6 related to degenerative changes. Compared to the prior exam the patient is currently in the extended neck position whereas previously the patient's neck was in a somewhat flexed position. This difference in position may account for the differences of appearance of the degree of spinal stenosis between the current prior exam and the prior exam.