Concluded Case

Multiple vertebral metastasis involving D8,D12,L1,L2 L3 .

New case 66 yr ,M, presented with mudthorasic pain of 2 weeks, stiffness and buckling of knees for 10 days,mild hesitancy in passing urine for 1 week. Mid thoracic pain is intermittent ,more on lying down and sitting positions. Sneezing and coughing used to aggravate the pain.For the last 10 days he has heaviness of both legs ,left more than right with bucking of the knees while walking.Able to pass urine and the sensation of micturition is intact but taking time to initiate micturition. Known case of perampullary CA pancreas,on regular follow up. On exam vitals stable. Bp140/ 80 mmhg Motor system gr4/5 power both lower limbs. All other groups were normal . Adductor spasticity both sides.Bilateral hyperreflexes for knee and ankles .Abdominal reflexes absent with flexor plantars. Dulling of sensations all modalities from D8 down. What abnormality in the MRI spine, Diagnosis with management?

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Concluded answer

Thanks for all answeres. MRI spine: * T2 / STIR hyperintense expansile lesion involving the L2-3 vertebral bodies and posterior elements with prevertebral and epidural soft tissue component causing significant spinal canal stenosis. * Loss of vertebral hight and altered signal intensities at D8 vertebra extending to bilateral posterior element . * Compression tract of D12 verebra with marrow signal changes extending to posterior elements on Rt side. * Well defind T1/ T2 hypointense lesion in the anterior aspect of L1 body. Features suggestive of multiple vertebral metastasis involve D8,D12,L1 L2,L3 vertebra. Spinal decompression done after discussing with the oncologist by the Spinal surgeon and then transferred to the oncology for further management.

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Multiple levels affected Posterior elements involved Paraspinal mass plus Secondaries are first possibility Multi focal tuberculosis a rare possibility Need further evaluation CBC esr Chest xray PSA levels Unlikely to be myeloma Canal stenosis with paraparesis Will benefit from decompression Neurosurgery evaluation

Thanks for all answeres. MRI spine: * T2 / STIR hyperintense expansile lesion involving the L2-3 vertebral bodies and posterior elements with prevertebral and epidural soft tissue component causing significant spinal canal stenosis. * Loss of vertebral hight and altered signal intensities at D8 vertebra extending to bilateral posterior element . * Compression tract of D12 verebra with marrow signal changes extending to posterior elements on Rt side. * Well defind T1/ T2 hypointense lesion in the anterior aspect of L1 body. Features suggestive of multiple vertebral metastasis involve D8,D12,L1 L2,L3 vertebra. Spinal decompression done after discussing with the oncologist by the Spinal surgeon and then transferred to the oncology for further management.

Multiple level bony destruction but significantly loss of vertebral body and cord compression at L2. In view of underlying history of carcinoma Mets should be 1st considerable diagnosis. As of now spine stabilization by external brace with urgent surgical decompression followed by appropriate chemo-radiotherapy

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Multiple lesions involving body and neural arches of multiple dorso lumbar vertebrae with paravertebral extension. secondary compression collapse fractue. _ metastatic lesions.signigicant nerve root compression at L2 Whole body PET scan .followed by oncological evaluation for chemoradiation therapy

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Metastasis. Evaluate for other mets. Radio&chemo now.

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?Bone TB

Thank you doctor
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