Clinical question: r/o transverse myelitis and cord lesionSigns and Symptoms: b/l LE weakness. L>RComments: Thoracic, Lumbar, and Sacral. Will require sedation. | MRI thoracic spine:There is a 53x42 axial dimension and 53x64mm sagittal dimension mass located in the right posteromedial thoracic cavity abutting the right side of the T1 through T8 vertebral bodies which insinuates into the right sided neural foramina foramina from T1-2 through T6-7 especially at T3-4, T4-5 and T5-6 which it extends through the neural foramina into the spinal canal where ir compresses the thecal sac from the right side and flattens the spinal cord.The mass also extends along the posterior aspect of the mediastinum and displaces and compresses the trachea and bronchi and abuts and compresses the venous structures of the upper mediastinum and displaces the heart and aorta and great vessels.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a well formed disk at S1-S2. The bladder is large.No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.Large intrathoracic mass abutting he T1 through T8 vertebral bodies extends into the spinal canal through the T3-4, T4-5 , T5-6 right neural foramina behind the T2-T6 vertebral bodies where it markedly compresses the spinal cord. Differential consideration includes neuroblastoma as well as other neoplasms.2.The same mass compresses and narrows mediastinal airway structures and mediastinal vascular structures (especially veins). A CT chest would be of further benefit to evaluate this.3.Enlarged bladder may be neurogenic given the above findings.4.There is no compromise to the lumbar spinal canal.