Clinical question: Cervical spine degenerative changes noted on CT. Signs and symptoms: Neck pain. Pre and post enhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise. Incidental note is made of a well demarcated T1 hypointense and T2 hyperintense rounded lesion with rim of enhancement on the right and is believed to arise from the right tonsil (axial T2 series 701 image 30, axial post enhanced series 1/2/2001 images 26 through 32). This finding is associated with an adjacent enhancing solid component which is best appreciated on post contrast series. This mass measures at 22.5 x 17 mm in transaxial dimensions on axial post enhanced series image 29.C3-C4 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C4-C5 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C5-C6 demonstrate moderate disc disease and a central disc extrusion with mild inferior herniation posterior to the body of C6. The disc results in mass effect, flattening deformity and posterior displacement of the cord and moderate central spinal stenosis. Degenerative changes at this level also results in moderate left neural foraminal compromise. There is no detectable signal abnormality of the cord.C6/C7 demonstrate moderate disc disease and loss of disc height, a small central disc protrusion is noted, moderate asymmetric left uncovertebral hypertrophy and mild on the right results in significant left and moderate right neural foraminal compromise.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord to T4 level is unremarkable.Findings on this exam and including mass of the right tonsil were discussed by phone with Dr. Elisabeth Blair at the time of review of the study.
1.Partially cystic and partially solid enhancing mass of the right tonsil as detailed/measured above.2.Degenerative changes at C5-C6 and with a large extruded/migrated disc fragment results in moderate central spinal stenosis.3.Degenerative changes at C6/C7, a small central disc protrusion and asymmetric (L>R) uncovertebral hypertrophic changes with resultant significant left and moderate right neural foraminal compromise without central spinal stenosis.4.No detectable signal abnormality of cervical or upper most visualized thoracic cord.5.No detectable abnormal enhancement to vertebral column or the leptomeninges to suggest metastatic disease.