9b (Spine) - Answer: 74-year-old female reports with lumbar spine pain

HISTORY: 

This 74-year-old female reports with lumbar spine pain.


PRIMARY FINDING: 

3cm abdominal aortic aneurysm at L3-4.


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


FINDINGS:

3cm abdominal aorta aneurysm at the L3-4 level. 

Susceptibility artifact overlies the right hip, consistent with total hip replacement. 

Status post hysterectomy. 

5mm left renal cyst. 

Right psoas muscle atrophy. 

The vertebral bodies are of normal height. Left lumbar scoliosis. Bone marrow signal is of normal intensity. 

The conus terminates at the L1-2 level and is abnormal in signal intensity in both the conus and the visualized portion of the thoracic cord from the inferior endplate of T11 to the conus, terminating at L1, hyperintense on T2 and STIR imaging with suggestion of prominent pial vessels, consistent with cord edema/ischemia and possible dural AVF and less likely AVM. 

T11-12 through L2-3: No compressive discopathy. No central canal stenosis, foraminal stenosis, or nerve root compression. 

L3-4: Mild to moderate decrease in disc height and desiccation. Endplate irregularity secondary to osteochondrosis with sterile reactive bony endplate changes rightward. Noncompressive anterior protrusion and anterior spondylosis. Shallow broad-based protrusion with moderate right and severe left facet arthropathy, mild ligamentum flavum hypertrophy results in indentation of the thecal sac, mild central canal stenosis and lateral recess stenosis with mild to moderate left and moderate to severe right foraminal narrowing with abutment of the exiting L3 nerve roots bilaterally, right greater than left, and the descending L4 nerve roots. 

L4-5: Disc desiccation. Shallow broad-based protrusion with moderate right and severe left facet arthropathy with capsulosynovitis, mild ligamentum flavum hypertrophy results in borderline mild central canal stenosis with mild right and moderate left foraminal narrowing with abutment of the exiting left L4 nerve root and descending L5 nerve roots bilaterally. 

L5-S1: Disc desiccation. Shallow broad-based disc displacement with mild to moderate right and severe left facet arthropathy with capsulosynovitis results in mild to moderate left foraminal narrowing and abutment of the exiting left L5 nerve root. 


CONCLUSION

1. 3cm abdominal aortic aneurysm at L3-4. 

2. Increased T2 and STIR signal hyperintensity noted within the distal cord and conus with suggestion of prominent pial vessels, most consistent with cord edema / ischemia. Recommend dedicated MRI scan of the cervical and thoracic spine both with and without contrast as the next step in the diagnostic algorithm to exclude dural AVF and less likely AVM. 

3. Left lumbar scoliosis with trilevel degenerative disc disease and disc displacements as detailed above with mild multifactorial central canal stenosis L3-4 and borderline mild central canal stenosis L4-5. 

4. Please see body of the report for level-by-level description and additional findings.


Discussion
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  MSK MRI
  Neuro MRI