5b (Spine) - Answer: 22-year-old male presents with neck and back pain

HISTORY: 

This 22-year-old male presents with neck and back pain after a recent motor vehicle accident.


(QUIZ ANSWER) WHERE PRIMARY FINDING CAN BE SEEN: 

The spinal cord at T7-8.


Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.


FINDINGS: 

No evidence of thoracic spine fracture and vertebral body heights are normal. Intervertebral disc spaces are normal in signal and height. Endplates are intact.

Cervicothoracic and thoracolumbar junctions are intact. Thoracic spine alignment is anatomic without spondylolisthesis. Anterior and middle columns are intact as well as the anterior and posterior longitudinal ligaments. No focal ligamentous disruption or epidural fluid collection is appreciated.

Vertebral marrow signal appears normal.

Spinal cord is normal in signal but demonstrates anterior effacement in the mid dorsal spine at the T7 and T8 levels with marked flattening of the posterior cord contour in short axis (cord effacement extends longitudinally for 4.4cm).

T1-2: No focal disc herniation, spinal canal stenosis, or foraminal narrowing. Facet joints appear normal.

T2-3: No focal disc herniation, spinal canal stenosis, or foraminal narrowing. Facet joints appear normal.

T3-4: No focal disc herniation, spinal canal stenosis, or foraminal narrowing. Facet joints appear normal.

T4-5: No focal disc herniation, spinal canal stenosis, or foraminal narrowing. Facet joints appear normal.

T5-6: No focal disc herniation, spinal canal stenosis, or foraminal narrowing. Facet joints appear normal.

T6-7: No focal disc herniation, spinal canal stenosis, or foraminal narrowing. Facet joints appear normal.

T7-8: No focal disc herniation, spinal canal stenosis, or foraminal narrowing. Facet joints appear normal. Abnormal flattening of the thoracic cord into the anterior retrovertebral space.

T8-9: No focal disc herniation, spinal canal stenosis, or foraminal narrowing. Facet joints appear normal.

T9-10: No focal disc herniation, spinal canal stenosis, or foraminal narrowing. Facet joints appear normal.

T10-11: No focal disc herniation, spinal canal stenosis, or foraminal narrowing. Facet joints appear normal.

T11-12: No focal disc herniation, spinal canal stenosis, or foraminal narrowing. Facet joints appear normal.

T12-L1: No focal disc herniation, spinal canal stenosis, or foraminal narrowing. Facet joints appear normal.

Prevertebral and paraspinal soft tissues appear normal.

Visualized costovertebral junctions are intact.

Visualized thoracic inlet and mediastinum appear normal.

Visualized lungs are clear.

Visualized soft tissues of the upper abdomen are normal.

Visualized ascending and descending aorta are normal. No aneurysm.

No indirect signs of cardiomegaly.

Esophagus and wall thickness is normal. No hiatal hernia.


CONCLUSION:

1. Dominant segmental anterior herniation of the spinal cord at T7 and T8. Celiac and SMA takeoff at the T12 level with lowest disc L1-L2. Note inferior margin of the herniated cord is at the posterior most costophrenic angle based on the lateral projection.

2. No recent fracture or posterior interspinous soft tissue injury.


Discussion
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  MSK MRI
  Neuro MRI