 Again seen is a large right apical lung mass invading into the upper thoracic vertebra from T1 through T4. There also appears to be subtle involvement of the anterior superior aspect of the T5 vertebral body, sagittal post gadolinium image 5.The enhancing mass measures approximately 8.4 x 9.9 x 9.6 cm in the AP, transverse, and craniocaudal dimensions, and demonstrates areas of central necrosis. There is a pathologic fractures involving the T2 and T3 vertebral bodies with 60-70% height loss. There is mild associated posterior bulging of the cortex/osseous retropulsion of T2 and T3 as well as epidural tumor. There is near complete effacement of the CSF space in the thecal sac at the T2-T3 level with cord deformity. Subtle T2 hyperintensity in the thoracic cord is suspected at the T2-T3 levels.Epidural tumor is noted from the mid T1 to the lower T4 levels. Tumor obliterates the right T2-T3, T3-T4, and to a lesser degree T1-T2 neural foramina. There is infiltration of the right T2 and T3 pedicles, transverse processes, and lamina as well as the right T4 pedicle and transverse process. Also noted is invasion of the right upper thoracic ribs. There is evidence of left-sided pneumonectomy. No lesions elsewhere in the thoracic spine are appreciated.
1. Enhancing 8.4 x 9.9 x 9.6 centimeter mass involving the right lung apex with invasion into the thoracic spine from T1 to T5 as detailed above. There is epidural tumor from the mid T1 to the lower T4 levels. There is also involvement of the right T2-T3, T3-T4, and to a lesser degree T1-T2 neural foramina. There are pathologic compression fractures of T2 and T3 vertebral bodies with 60-70% height loss. There is moderate to severe spinal canal narrowing at T2-T3 level with deformity of the cord and suspected subtle cord signal abnormality.2. No additional lesions are seen elsewhere in the thoracic spine on the sagittal sequences. Please note comment in the technique section.