Metastatic lesion, back pain. History of renal cell cancer. Again seen are postsurgical changes of spinal canal decompression and posterior spinal fusion with hardware extending from the L1 to L5 levels. There are paraspinous rods with interconnecting devices as well as bilateral pedicle screws at L1-L2, on the right at L3, on the right at L4, and bilaterally at L5. Compared to 2/1/2015, there has been interval development of a large mass involving the lumbar spine and paraspinous musculature which extends from the L2-L3 to the L5 levels. Susceptibility artifact makes evaluation difficult, however, there is infiltration of the L3 and L4 vertebral bodies left greater than right with extension into the posterior elements. There is associated marked spinal canal stenosis at the mid L4 level. There is also severe effacement of the right L3-L4 and left L3-L4 and L4-5 neural foramina. Mass measures at least 9 x 14 cm in the AP and transverse dimensions with craniocaudal extent as above. There is mild loss of height involving the L3 and L4 vertebral bodies on the left. Vertebral body heights and alignment are otherwise maintained.There is a thin peripherally enhancing fluid collection dorsal to the thecal sac measuring approximately 1 cm in thickness and extending from the L2 to the L4-L5 levels. Large left retroperitoneal/renal mass again seen.
1. Compared to MRI lumbar spine dated 2/1/2015, there has been interval development of a large mass involving the lumbar spinal canal and paraspinal musculature extending from the L2-L3 to the L5 levels most compatible with tumor recurrence/progression. There is associated severe spinal canal stenosis at mid L4 level. There is also severe effacement of the right L3-L4 and left L3-L4 and L4-L5 neural foramina. Infiltration involving the L3 and L4 vertebral bodies and posterior elements and mild loss of height on the left are compatible with pathologic fractures.Given the susceptibility artifact related to the hardware, CT may be helpful for further delineation of the tumor and hardware.2. Thin peripherally enhancing fluid collection in the surgical bed measuring approximately 1 cm in thickness and extending craniocaudally from the L2 to the L4-L5 levels dorsal to the thecal sac. Possibility that this fluid collection represents an abscess cannot be excluded and sampling can be considered as clinically warranted.3. Large left retroperitoneal/renal mass is again seen.Dr. Ali discussed findings Dr. Deshmukh at 1437 hrs.