Worsening low back pain with possible compression fracture at T12. Five lumbar type vertebral bodies are presumed to be present. Bone marrow demonstrates diffuse low T1 signal with heterogeneity and multiple round lesions throughout the lumbar spine and visualized pelvis, findings highly suspicious for metastatic disease. Relatively larger lesion is seen involving the L2 vertebral body. Lesions involving the posterior elements are also noted. There is approximately 30% loss of height involving the T12 vertebral body suspected to represent a pathologic fracture. Vertebral body heights in the lumbar spine are otherwise normal. There is minimal retrolisthesis of L3 on L4. Alignment is grossly maintained.There is soft tissue dorsal to the T12 and L2 vertebral bodies suspected to represent epidural tumor in the ventral spinal canal. Relatively thicker ventrolateral epidural tumor at the left L2 level measures up to 7 mm in thickness. There is however no significant associated central canal stenosis.There are multilevel degenerative changes are seen, as described below:L1-L2: No spinal canal or neural foraminal stenosis.L2-L3: There is mild narrowing of the neural foramen on the left partially related to epidural tumor, which is mostly superior to the level of the neural foramen at the mid L2 level. There is no significant central canal stenosis or right neural foraminal narrowing.L3-L4: There is minimal retrolisthesis and disc bulge, which is eccentric to the left. There is mild narrowing of the left neural foramen. There is contact of the extraforaminal left L3 nerve root related to far lateral component of the disc bulge. No significant central canal or right neural foraminal stenosis.L4-L5: There is mild spinal canal stenosis related to combination of disc bulge, ligamentum flavum thickening and facet arthropathy. There is moderate right and minimal left neural foraminal narrowing.L5-S1: There is severe loss of disc height and mild bulge. There is no significant central canal stenosis. There is mild to moderate bilateral neural foraminal narrowing.Multiple enlarged retroperitoneal lymph nodes are evident.
1. Multiple osseous lesions throughout the lumbar spine and pelvis highly suspicious for osseous metastatic disease. Mild epidural tumor is suspected at the T12 and L2 levels which can be better assessed with postcontrast sequences. There is however no significant associated spinal canal stenosis. Mild pathologic compression fracture at T12 is also noted.2. Extensive retroperitoneal lymphadenopathy also compatible with metastatic disease. Consider dedicated CT chest, abdomen, and pelvis study.3. Multilevel degenerative changes, relatively worse at the L4-L5 level, where there is mild central canal stenosis and moderate right neural foraminal stenosisDr. Ali discussed findings with Dr. Schwartz at 1150 hrs on 12/21/2015