Concluded Case

Biopsy Repirt Adenocarcinoma with papillary areas.

New case 43 yr ,M ,Presented with upper dorsal pain 1 month,intermittent pain from back radiating to left side of chest at times rt also up to the nipples since 2 weeks ,feeling of weakness with occassional buckling of knees since 5 days,numbness below the nipple since 3 days with difficulty to pass urine in the form of strain to pass urine with intact fullness of bladder and sensation of passing urine. No previous history of any medical illness. On exam vitals stable,BP 140/ 80 mmhg. Intact cranial nerves,upper limbs power gr5/5 with normal DTRS and sensations . Lower limbs ge 4/5 power with mild spasticity with hyperreflexes,absent abdominal reflexes with upgoing plantars. Dulling of sensations all modalities fron D4 down. No spinal tenderness noted. What abnormality in the NRI,diagnosis and management?

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Concluded answer

Thanke Curofy and all others. MRI dorsal spine : * Near complete collapse of D3 vertebra with altered marrow signals and pist contrast enhancement involving the posterior 1/ 3rd of the body,pedicle,posterior elements and spinoff process,rt pedicle appears expanded with liss of definition, posterior vertebral margin appears convexly bulging and extruding in to the spinal canal causing spinal cord compression. * Prevertebral and both paravertebral enhancing soft tissue at same D3 level. * Alteted marrow signals & post contrast enhancement also seen in the D2 & D4 vertebral bodies postrocentrally.D2 and D4 spinoff process proximal aspectSTIR hyoerintensities and post contrast enhancement also seen in the D2 & D4 vertebral bodies postero centrally. * No end plate destruction or features of discitis on these vertebrae. * Old fractured verebral body. FINDINGS SUGGESTIVE OF MARROW INFILTRATIVE PATHOLOGY LIKE MYELOMA VS METASTASIS. ESR 24 MM/ HR. Tumor markers negative. Space over,shall c

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Thanke Curofy and all others. MRI dorsal spine : * Near complete collapse of D3 vertebra with altered marrow signals and pist contrast enhancement involving the posterior 1/ 3rd of the body,pedicle,posterior elements and spinoff process,rt pedicle appears expanded with liss of definition, posterior vertebral margin appears convexly bulging and extruding in to the spinal canal causing spinal cord compression. * Prevertebral and both paravertebral enhancing soft tissue at same D3 level. * Alteted marrow signals & post contrast enhancement also seen in the D2 & D4 vertebral bodies postrocentrally.D2 and D4 spinoff process proximal aspectSTIR hyoerintensities and post contrast enhancement also seen in the D2 & D4 vertebral bodies postero centrally. * No end plate destruction or features of discitis on these vertebrae. * Old fractured verebral body. FINDINGS SUGGESTIVE OF MARROW INFILTRATIVE PATHOLOGY LIKE MYELOMA VS METASTASIS. ESR 24 MM/ HR. Tumor markers negative. Space over,shall c

Old awc fracture D12 D3 collapse Disc spaces preserved Cord compression Extradural mass Plasma cytoma a possibility CBC esr Serum protein electrophoresis Urine bence Jones protein Chest xray PSA levels Need decompression and biopsy

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Continuatoon of conclusion due to limited space. BJ protein immuno- electrophoresis- specific abnormalities. CT CHEST and abdomen, mRI brain normal. Surgery done- D3 Corpectomy+ 360 degree decompression + biopsy+ posterior instrumentation D1 to D5 under GA on 12 jan . Pt is better,ambulant. Biopsy report already noted in the conclusion. PET CT POSTED ON 20TH. PT IS STILL IN THE HOSPITAL.

1. Compression collapse fracture of D3 with retropulsion of fracture fragment alongwith enhancing paravartebral soft tissue lesion causing compression over dorsal cord with regional cord oedema. 2 signal abnormality also in D2 andD4 . Primary possibility infective spondylitis . ( ?paradiscal tuberculous ) . Fnac from psraspinal soft tissue lesion .treatment accordingly under neurological supervision

Case of comppessive mylopathy at d3d4level. Looks like kochs spine with neurodeficit. Spastic parapersis with bladder getting involved. Xray chest blood tests to confirm kochs.the pathology must be atacked from laterally affed vertebralbodies removed&iliac bone graft is kept. Later the graft must be fuxed with rods&scrwes. Att with steroids started. Specimen must be sent forhpe. Later good physiotherapy.

Potts spine Calcified lt hilar Opinion of orthopedic & repair 1 1/2 month strict bed rest Radiculopathy Pressure on nerve root affecting Lumber & lower limb

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classical kochs spine...needs surgery...most surgeons do transthoracic supra major high morbidity surgery...I have been doing age old but very less mutilating anterolateral decompression....have done more than 200 cases by now...excellent outcomes and none given fixation...at the most bone graft is bony loss is more than 50% and external brace... in thoracic region, the rib cage acts as a good splint and fixation has never been needed later also...I have patients following for 10+ years too..all ambulatory and functional...just thought to share my experience which is now a rarity to find a surgeon doing this surgery...thanks madam

Compressive myelopathy at c5-6 and T1-T2 level,most likely a lung metastasis,needs surgical intervention mam

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Its appendicicalkochs with involment of posterior part of spinal colun radiologically. Ct guided fnac may be done for confirmation

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