History of poorly differentiated adenocarcinoma presumed from the lung, with symptomatic spinal cord compression near the T1, T2, and T3 levels due to pathological fracture and cord compression. There are postoperative findings related to upper thoracic laminectomy. There is a pathological fracture of the T1 vertebral body with near complete loss of height and retropulsion of bone and tumor posterior into the spinal canal measuring 7 mm in width, which results in spinal cord compression and edema. There is also approximately 9 mm of anterior subluxation of the cervical vertebral column. The rest of the thoracic spinal column alignment is intact. There is a bulky soft tissue tumor arising from the left T1 posterior elements that projects into the paraspinal soft tissues, where there is extensive edema. There is obliteration of the bilateral T1-2 neural foramina. There is also a mass situated alongside the right T11-12 level measures up to approximately 4 cm mainly projects into the paraspinal soft tissues, where there is extensive edema, but may also have slight extension into the adjacent neural foramen. There is a focus of T2 hyperintensity in the right posterior elements of the T2 vertebra. The previously demonstrated pulmonary nodules are better depicted on the prior chest CT.
1. Pathological fracture of the T1 vertebral body with near complete loss of height and retropulsion of bone and tumor posterior into the spinal canal resulting in spinal cord compression and edema, as well as approximately 9 mm of anterior subluxation of the cervical vertebral column. Bulky soft tissue tumor arising from the left T1 posterior elements otherwise projects into the paraspinal soft tissues. 2. A metastasis situated alongside the right T11-12 level measures up to approximately 4 cm mainly projects into the paraspinal soft tissues, but may also have slight extension into the adjacent neural foramen.3. A focus of T2 hyperintensity in the right posterior elements of the T2 vertebra may represent an additional site of metastatic disease. Discussed with Dr. Ramos at 10 AM on 2/21/16.