Relapsed mul multiple myeloma, status post fall. Evaluate for fracture or mass. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is minimal L5-S1 retrolisthesis, alignment is otherwise maintained. Small osseous lesions are again seen such as at the dorsal L3 vertebral body compatible with known myeloma. L2 lesion with T1 hyperintensity most compatible with a benign hemangioma. No large lesions or compression fractures.There is extensive enhancing epidural tissue surrounding the lower thoracic cord extending superiorly outside the field-of-view and extending inferiorly to the upper L3 level. The more bulky component is at L1 and L2 levels. There is partial encasement of the lower thoracic cord, conus, as well as the cauda equina with mass-effect and leftward displacement. There is mild T2 hyperintensity within the visualized conus with swelling. There is soft tissue within the right T12-L1, L1-L2, and L2-L3 neural foramina. There is right paraspinous mass which is in contiguity with the epidural and right neural foramina tumor. The mass extends along the enlarged right psoas muscle inferiorly. There is T2 hyperintensity/edema involving the inferior aspect of the right psoas muscle which may be reactive.Degenerative changes are also seen in the lumbar spine with disk desiccation at L5-S1. There is moderate right and mild left L4-L5 neural foramina stenosis and mild to moderate right and mild left L5-S1 neural foramina stenosis related to disk bulge and facet arthropathy. No spinal canal stenosis is seen inferior to the mid L3 level.
1. Small osseous lesions in the spine and pelvis consistent with known multiple myeloma. No large lesions or compression fractures. Burden of osseous lesions can be correlated with prior PET studies. 2. Extensive epidural enhancing soft tissue with mass effect on the conus and upper cauda equina nerve roots extending inferiorly to the mid L3-level is most consistent with neoplasm. Please refer to separate thoracic spine MRI report for superior extent of tumor. Tumor extends to involve the right T12-L1, L1-L2, and L2-L3 neural foramina. There is also a right paraspinous mass which is in contiguity with the epidural and right neural foramina tumor. The mass extends along the enlarged right psoas muscle inferiorly with superimposed hemorrhagic psoas component not excluded.3. Edematous appearance of the conus with T2 hyperintensity. 4. Please refer to separate reports for findings in the pelvis as well as cervicothoracic spine. Findings of most likely epidural tumor at the thoracolumbar junction were discussed with Dr. Ramos (Neurosurgery) at 10 am on 1/22/2015. 