Diagnosis: Acute lymphoblastic leukemia not having achieved remission. Acute lymphoblastic leukemia not having achieved remissionClinical question: patient with lytic lesions in T spine seen on CT scan There are multiple foci of marrow replacement and contrast and enhancement scattered throughout the thoracic spine and in general throughout the visualized spine. There is partial compression of T11. Involving the left half of the T11 vertebra more than the right with approximately 30% loss of vertebral body height there is no evidence for retropulsion or compromise to spinal canal.Multiple marrow replacing lesions are also identified in the other visualized skeletal structures including the ribs and scapula.There is no compromise of thoracic spinal canal or exiting nerve roots.There is a large left-sided pleural effusion associated with airspace disease. There are multiple nodules present in the visualized portion of the right lung. There is a small right pleural effusion present.
1.Findings are compatible with diffuse skeletal metastases involving the visualized portions of the spine with mild compression fracture at T11 without significant compromise to the spinal canal at this time. Skeletal metastases are also suspected in the ribs and scapula.2.There are multiple nodules identified in the visualized portions of the right and left lung. Please refer to chest CT from 10/13/2015 for further comments.3.Bilateral pleural effusions-the left pleural effusion is larger and associated with airspace disease whereas the right pleural effusion is much smaller.