Malignant neoplasm of unspecified kidney, except renal pelvis [C64.9], Reason for Study: ^Reason: s/p nephrectomy for RCC. R flank pain, L thigh numbness, ?periportal LN on OSH scans on PACS. Abd AND Lumbar MRI together please History: R flank pain, s/p For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is about 17.8mm x 15.4mm sized lesion on the L3 vertebral body which shows low signal intensity on T1 and high signal intensity on T2 with intense enhancement on Gad infusion.The lesion shows lamellated appearance on T1 and T2 weighted images indicating central soft tissue layer, surrounding sclerotic bone area and bone marrow edema which show enhancement. In addition, there is evidence of focal endplate defect which is associated with the lesion. Constellation of these findings are suggestive of acute Schmorl's node, however, single vertebral body metastasis cannot be completely excluded. Since bone scan may not differentiate two diagnostic possibilities, follow up imaging about 1-2 months with MRI with and without contrast is recommended. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance except L3 vertebral body. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level.The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.
1. Acute Schmorl's node, L3 vertebral body inferior end plate. Vertebral body metastatic lesion cannot be completely excluded considering the patient's history. Follow up MRI with and without contrast enhancement is recommended.2. Diffuse bulging of disc at the level of L34 and L45 as described above. Otherwise unremarkable.