Concluded Case

Metastasis from clear cell renal cell carcinoma

New Case. 64 yr ,M, Presented with back pain ,lower back mostly while lying down since 4 months.For the last 2 months he is having pain in the leg while standing and walking but Progressive in nature. He denied having any weakness,or sensory symptoms or bowel or bladder dysfunction.No loss of weight or appetite. Not a known diabetic or hypertensive but he is under Nephrology and investigation for renal impairment detected recently. On exam vitals stable, BP 150/ 80 mmhg,Local tenderness L1and L2 region . Motor system gr5 /5 power.DTRS equal,intact sensations. ESR 22mm/ hr,Creatinine 4.2 mg/ dl,blood urea56 mg/ dl,other biochemistry normal. Vasculiyis screening is normal. Tumor markers no abnormality detected MRI spine only plain scan.,contrast not given in view of the Creatinine value

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Concluded answer

Thanks for the answeres. MRU spine: Altered marrow signals with diffusion restriction and mild expansion of L1 vertebral body seen sparing 1/3 of body; also involving left pedicle, para interarticularis,lamina and left transverse process forming an irregular mass which extend inferiorly along the superior margin of left psoas muscle. Postetior vertebral cortex appears concave and bulging into spinal canal causing narrowing of L1level with expansion of conus medullaris. Laft neural recess and foramen appear infiltrated by the mass which is compressing the thecal sac. Imp : Above features suggestive a marrow infiltration lesion suggestive if metastasis. Further investigation shows renal carcinoma. Trans pedicular biopsy + percutaneous pedicle screw fixation done D12 to L2 under GA HPR : Metastasis from Clear cell renal cell carcinoma

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Thanks for the answeres. MRU spine: Altered marrow signals with diffusion restriction and mild expansion of L1 vertebral body seen sparing 1/3 of body; also involving left pedicle, para interarticularis,lamina and left transverse process forming an irregular mass which extend inferiorly along the superior margin of left psoas muscle. Postetior vertebral cortex appears concave and bulging into spinal canal causing narrowing of L1level with expansion of conus medullaris. Laft neural recess and foramen appear infiltrated by the mass which is compressing the thecal sac. Imp : Above features suggestive a marrow infiltration lesion suggestive if metastasis. Further investigation shows renal carcinoma. Trans pedicular biopsy + percutaneous pedicle screw fixation done D12 to L2 under GA HPR : Metastasis from Clear cell renal cell carcinoma

Secondary compression collapse fracture of L1 ( D12 if L5 is transitional vertebra) with paravertebral soft tissue component with epidural extension causing compression over cordo conal region and mild regional cord oedema. Primary probability is infective spodylitis . ( ? Tuberculous) . FNAC will be helpful

Dd Definitely c7 d1 Potts spine Biopsy HP Opinion of orthopedic

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