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TEMPLATES

ACL TEAR

There is evidence of a fluid filled cleft within the ACL seen 8.5 mm beyond its femoral
origin with complete disruption of its fibers suggestive of a complete tear. The gap
between the ends of the torn ligament measures 3.5mm. No significant anterior tibial
translocation is seen.

The anterior cruciate ligament appears mildly attenuated in caliber. Subtle focal hyper
intensity is noted within the substance of the ligament at its femoral attachment. There
is no disruption of its anterior fibers, however posterior fibers appear ill defined. Few tiny
STIR hyperintense cysts are seen in relation to the tibial attachment of the anterior
cruciate ligament probably representing cruciate cysts/ ganglion cysts.

The anterior cruciate ligament shows thickening with intraligamentous hyperintensity


signal on PD fat-saturated images however the fibers of the ligament are intact.

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OSTEOARTHRITIS KNEE

MENISCAL TEAR

There is evidence of a localized partial thickness superior/ inferior surface tear which
does not reach the meniscal periphery.

There is evidence of a full thickness tear-----


There is evidence of a superior or inferior surface tear that extends to the meniscal
periphery

There is evidence of a broad based tear that reaches the meniscal periphery

RADIAL TEAR
There is evidence of a 10.8 mm sized radial tear extending from the free edge upto the
substance of the body of the lateral meniscus.
Complex tear
There is evidence of a complex tear involving the peripheral aspect of the anterior horn,
just beyond the anterior root attachment of the lateral meniscus, having horizontal and
longitudinal components. The horizontal component of the tear measures 11 mm and is
seen to extend into the body of the meniscus up to the periphery. Multiple small,
lobulated, STIR hyperintense parameniscal cysts are seen in relation to the tear.
Pelvis mass
There is evidence of moderately large, well defined, complex solid cystic pelvic mass
lesion seen in both adenexal regions, extending cranially up to the level of the
umbilicus. The cystic component appears multiloculated and is uniformly hyperintense
on the T2W and STIR images with peripheral rim enhancement. The solid component
reveals restricted diffusion and early peak enhancement on dynamic study. Both ovaries
cannot be seen separately. The uterus is partially encased by these lesions and the
serosal fat planes appear effaced. The mass lesion measures about x cm ( AP X
TRANS)
Bilateral moderately large, conglomerate complex adnexal mass lesions encaseing the
uterus.

SPINE
The partially dessicated C5-C6 disc shows right posterlateral protrusion obliterating the
adjacent sub arachnoid space and causing compression on the ipsilateral ventral nerve
root
Rest of the cervical intervertebral discs appear normal. No focal or generalized bulge is
seen.
Straightening of the spine with loss of normal lordosis representing muscular spasm is
noted.
The dessicated C4-C5 to C6-C7 discs show subtle degenerative posterior bulge without
causing compression on the adjacent subarachnoid space or ventral nerve root.
The whole spine high resolution T2 weighted images in sagittal plane reveal
sacralisation of the L5 with associated degenerative posterior bulge of L4-L5 disc.
Spinal cord appears normal and does not reveal any focal signal abnormality. No
evidence of cord compression or displacement is seen.

Osteoarthritis

There is reduction in joint space involving the medial compartment of the tibio-femoral
joint and medial patella-femoral joint. Marginal patellar, femoral and tibial osteophytes
are noted. There is complete loss of cartilage along the articulate surfaces of the medial
tibio-femoral and medial patella-femoral joint. The cartilage over the lateral tibio-femoral
and lateral patella femoral joint appear intact. Few subchondral cystic changes are seen
along the medial tibial condyle and medial facet of the patella. Il-defined marrow edema
is seen involving the medial femoral condyle extending upto the subchondral region
representing bone marrow edema.
Moderate joint effusion is noted with moderate supra patellar bursal effusion.
Moderate degree of osteoarthritis involving the medial compartment of the tibio-femoral
joint and medial patella-femoral joint with associated .marrow edema involving the
lateral condyle. Moderate degree of suprapatellar bursal effusion.

Dr. Raj Koticha


DMRD , DNB

Lateral meniscus shows complete loss of morphology and outline with diffuse
hyperintense signal on PD fat-saturated images consistent with advanced degenerative
tear.

The anterior cruciate ligament shows thickening with intraligamentous hyperintensity


signal on PD fat-saturated images however the fibers of the ligament are intact.

Surrounding muscles appear grossly unremarkable however edematous changes are


noted in the subcutaneous tissue.

Cervical spine

Cervical spine shows reversal of lordotic curvature.

The lumbar spine shows exaggerated lumbar lordotic curvature

Degenerative changes are seen at C4-C5 and C5-C6 levels in the form of reduced
intervertebral disc height and osteophytic changes. Due to reversal of lordotic curvature,
there is partial effacement of the ventral thecal sac. Uncinate hypertrophy seen
bilaterally at these levels causing narrowing of the neural foramina however no
significant nerve root compression is observed. There is no compression upon the
spinal cord.
Mild diffuse disc bulges are seen at L2-L3 mild L4-L5 and L5-S1 levels causing
indentation on ventral thecal sac however no significant compression upon traversing or
exiting nerve root seen.

The anterior-posterior spinal canal diameter at L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1
levels are 10.5 mm, 10 mm, 9.5 mm, 9.8 mm an 11.2 mm respectively.

EXTRUDED

The dessicated L4-L5 intervertebral disc reveals left posterolateral protusion with an
extruded fragment measuring 8mm extending caudally on the left side causing
compression on the adjacent thecal sac and ipsilateral traversing L5 and to a less
extent exiting L4 nerve root.

Left posterolateral protusion of the dessicated L4-L5 intervertebral disc with an extruded
fragment extending caudally on the left side causing compression on the adjacent
thecal sac and ipsilateral traversing L5 and to a less extent exiting L4 nerve root.

Transitional vertebra is seen and labelled as L5 which is partially sacralised.


Right-sided spondylolysis of L5 is seen without listhesis.

OPLL

There is a thickened linear signal along the posterior margin of the cervical vertebral
bodies extending from the C3/C4 disc level to the superior endplate of T1. The
appearance is consistent with ossification of the posterior longitudinal ligament. The AP
diameter of at the C3/C4 disc level is only 5.47mm. The normal AP diameter in the
cervical spine is 13-20mm. Neurologic symptoms present with an AP diameter < 8mm

there is marked narrowing of the AP diameter of the spinal canal due to the ossified
ligament with flattening of the cord

At C4/C5, there is similar narrowing of the spinal canal with deformity of the spinal cord
(yellow). The neural foramina are moderately narrowed, right greater than left (red).

there is contact of the ventral surface to the cord with the ossified posterior longitudinal
ligament without significant cord Deformity (yellow)
bilateral neural foraminal narrowing from uncovertebral joint osteophytes. uncinate
hypertrophy seen bilaterally at these levels causing narrowing of the neural foramina

diffuse bone marrow infiltration of the cervical, thoracic, lumbar and sacral spine,
involving body as well as the posterior elements with appear hypointense on T1- and
hyperintense on fat-suppressed T2-weighted images

Rest of the lumbar intervertebral discs are normal. No evidence of focal or generalized
bulge is seen.

Facet joints at L4-L5 level show degenerative changes. In addition mild ligamentum
flavum thickening is also noted.

Fistula in ano.

There is evidence of a well-defined, irregular, thick walled, T2 hyperintense and T1


hypointense tract seen arising from the site of marker in the right perianal region,
forming a V shaped configuration. Both tracts are seen to travel almost in the same
cranio-caudal plane with minimal anteroposterior separation.

The first limb of the V shaped tract is seen to extend cranially to pierce the external
sphincter, enter the intersphinteric plane and open into the anal canal at 6`o clock
position.

The second limb, which has a slightly more cranial course than the first limb, is seen to
travel in the intersphincteric palne and is seen to terminate into a 8.9x 5.9mm collection,
entirely within the intersphincteric plane at 7`o clock. No opening into the anal canal is
seen.
The anal canal appears mildly thickened. Mild ill-defined inflammatory stranding noted
along the fistulous tracts.

Linear, v shaped tracts extending from the site of the marker in the right perianal
region, of which one has a transphinteric course with opening into the anal canal at 6`o
clock position forming a fistula. The other tract has a intersphincteric course, which is
seen to terminate into a 8.9x 5.9mm collection, entirely within the intersphincteric plane
at 7`o clock, representing a sinus tract.
Fistulous tract is seen arising from the bilateral gluteal folds with formation of a
common tract in the midline with cranial course at 11 o'clock position and
transsphincteric extension into internal canal at 11 o'clock position at the level of
the root of penis ( perineum). No ramification or abscess formation is noted in the
fistulous tract. There is no extension of the fistula in the supralevator plane or in
the intersphincteric plane.
The prostate and seminal vesicles appear unremarkable
The rectum appears unremarkable. The mesorectal fascia and fat appears
unremarkable
The pelvic muscles appear unremarkable
No significant pelvic lymphadenopathy is seen
Visualized bones appear unremarkable

Impression MRI fistulogram reveals low type of infra levator transsphincteric


fistula at 11 o'clock position as described above.

SHOULDER

The acromion is of type II variety and shows lateral down sloping with small inferior
spur. There is mild hypertrophy of the coracoacromial ligament. As a result there is
narrowing of the sub acromial space and impingment on the supraspinatus tendon.

There is mild thickening of the capsule and synovium of the glenohumeral joint.
Hyperintense signal is seen within the axillary pouch which appears mildly thickened.
These findings are suggestive of mild adhesive capsulitis.

There is irregularity with subchondral edema seen in the articular margins of the
acromio-clavicular joint, suggestive of degenerative arthritis.

There is evidence of linear fluid signal paralleling the long axis of the tendon that does
not communicate with the articular or bursal surface representing an intratendinous tear

There is evidence of a fluid filled defect at the articular surface ,extending through
greater than 50% of the cuff thickness. The tear involves the tendon-bone interface at
the articular surface and extends slightly into the distal substance of the supraspinatus
tendon. The bursal sided fibers remain intact and attached at the rotator cuff footprint.

There is evidence of a U / cresenteric shaped / L shaped, full thickness tear


measuring mm in length and mm in width. The tendon edge is retracted medially to
the glenoid fossa. No extension of tear to subcapsularis or infraspinatus tendon is
noted. No muscle atrophy or fatty degeneration is seen.
Bursal-sided partial-thickness tear of the supraspinatus tendon.

Subdeltoid bursal fluid is present compatible with bursitis

MR imaging findings of muscle atrophy, superior migration of the humeral head, or


retraction of the tendon edge medial to the glenoid fossa are considered by some
orthopedic surgeons to be signs of irreparability.

Fluid is noted in the glenohumeral joint and subdeltoid bursa.

The long head of the biceps brachii tendon dislocated medially from the bicipital groove
deep to the superficial subscapularis tendon fibers.

LUMBAR SPINE REPORT

MRI SCAN OF LUMBOSACRAL SPINE

Multiplanar MR imaging of the lumbar spine was performed using a phased-array


spine coil and large FOV.

Transitional vertebra is seen and labelled as L5 which is partially sacralised.


Right-sided spondylolysis of L5 is seen without listhesis.

There is loss of lumbar lordosis. Minimal degenerative changes are seen in the form of
marginal osteophytes from L3-L5.
L4/5 disc shows diffuse posterior bulge indenting ventral subarachnoid space.
Mild facetal arthropathy is seen at L4/5 and L5-S1 levels.

Rest of the intervertebral discs appear normal.


The lower end of the spinal cord, cauda equina and filum terminale do not reveal any
abnormality.

No abnormality is detected in the prevertebral region. The vascular structures appear


normal.
Bilateral posterior paraspinal muscles are normal in size and reveal normal signal
intensity.
Spinal canal measurements are within normal limits.
Screening of the coccyx shows hyperintense signals on STIR images involving the first
and second coccygeal vertebrae with minimal subcutaneous oedema overlying it.

IMPRESSION:

Transitional vertebra is seen and labelled as L5 which is partially sacralised.


Right-sided spondylolysis of L5 is seen without listhesis.
Mild lumbar spondylosis.
L4/5 disc shows diffuse posterior bulge indenting ventral subarachnoid
space.
Hyperintense signals on STIR images involving the first and second
coccygeal vertebrae with minimal subcutaneous oedema overlying it
suggestive of a focal inflammatory/ reactive changes. Follow up is
recommended.

MRI SCAN OF LUMBOSACRAL SPINE

Multiplanar MR imaging of the lumbar spine was performed using a phased-array


spine coil and large FOV.

There is loss of lumbar lordosis.


Degenerative changes are seen in the form of marginal osteophytes from L1-L5.
Schmorls nodes with adjoining endplate oedema are seen involving the L3 and L4
vertebral bodies.

L3/4 and L4/5 discs are mildly degenerated.


L4/5 disc shows diffuse posterior bulge indenting thecal sac and encroaches on both
neural foramina.
L3/4 disc shows broad-based posterior bulge indenting thecal sac.
Mild facetal arthropathy is seen at L4/5 and L5-S1 levels.
There is no abnormal neuroparenchymal or meningeal enhancement seen.

The alignment of the vertebrae is normal.


Rest of the intervertebral discs appear normal.
The lower end of the spinal cord, cauda equina and filum terminale do not reveal any
abnormality.
No abnormality is detected in the prevertebral region. The vascular structures appear
normal.
Bilateral posterior paraspinal muscles are normal in size and reveal normal signal
intensity.

IMPRESSION:

Mild lumbar spondylosis.


Schmorls nodes with adjoining endplate oedema are seen involving the L3
and L4 vertebral bodies.
L4/5 disc shows diffuse posterior bulge indenting thecal sac and encroaches
on both neural foramina.
L3/4 disc shows broad-based posterior bulge indenting thecal sac.

OBSERVATION:

The alignment and the curvature of the lumbar spine is maintained.

Heterogeneous marrow signal is seen in all the lumbar vertebrae and they are relatively
hypointense on T1 weighted images. Type II modic change are seen in the anterior part
of the enplates.

There is partial desiccation of the L2-3 to L5-S1 intervertebral discs.

L3-4 disc reveals mild reduction in height. There is diffuse posterior bulge with moderate
sized posterocentral protrusion having inferior migration of about 8 mm, compressing
ventral thecal sac, encroaching bilateral neural foramina and indenting bilateral budding
nerve roots. Mild facetal arthropathy adds to the canal compromise.The residual canal
AP dimension is 8mm.

The dessicated L4-L5 intervertebral disc reveals left posterolateral protusion with an
extruded fragment measuring 8mm extending caudally on the left side, encroaching
bilateral neural foramina causing compression on the adjacent thecal sac and ipsilateral
traversing L5 and to a less extent exiting L4 nerve root.

The dessicated L4-5 disc reveals diffuse posterior bulge with posterior annular tear and
mild broad based right paracentral protrusion, indenting ventral thecal sac and
encroaching the right neural foramen, abutting the right budding nerve root.

The dessicated L5-S1 disc reveals diffuse posterior bulge with posterior annular tear
and small pocterocentral protrusion effacing the epidural fat.

Mild diffuse disc bulges are seen at L2-L3 mild L4-L5 and L5-S1 levels causing
indentation on ventral thecal sac however no significant compression upon traversing or
exiting nerve root seen.

Rest of the lumbar intervertebral discs appear unremarkable. No significant neural


compression or disc herniation is seen.

The dessicated C4-C5 to C6-C7 discs show subtle degenerative posterior bulge without
causing compression on the adjacent subarachnoid space or ventral nerve root.
The pedicles, laminae spinous process and transverse process of the lumbar vertebrae
show normal morphology. No evidence of spondylolysis.

The ligamentum flavum thickness is within normal limits.

The bony spinal canal diameter measures (mm)

Level L1-2 L2-3 L3-4 L4-5 L5-S1

Cm 16 15 12 11 12

The spinal cord and conus medullaris are normal.


The nerve roots of the cauda equina otherwise appear normal.

The paraspinal soft tissues appear normal.

Sacroiliac joints:

The sacroiliac joints appear normal. Mild diffuse wall thickening of the urinary bladder is
seen. The prostate is moderately enlarged. A suspicious T2 hypointense nodule
measuring 10 x 8 mm is seen in the left paramidline part of the gland.

Whole Spine Screening

There is mild heterogenous marrow signal seen in the dorsal vertebrae. Few schmorls
nodes are seen in the mid dorsal vertebral bodies. Small T2 hyperintense lesions are
seen in D6 and D7 vertebral bodies likely to be hemangiomas. No significant neural
compression or disc herniation is seen.

IMPRESSION:

Heterogeneous marrow signal in all the lumbar vertebrae and they are relatively
hypointense on T1 weighted images. Suggest- further evaluation for marrow
infiltration.

Type II modic change in the anterior part of the enplates. Partial desiccation of
the L2-3 to L5-S1 intervertebral discs.

L3-4 disc reveals mild reduction in height. There is diffuse posterior bulge with
moderate sized posterocentral protrusion having inferior migration of about 8
mm, compressing ventral thecal sac, encroaching bilateral neural foramina and
indenting bilateral budding nerve roots. Mild facetal arthropathy adds to the canal
compromise.The residual canal AP dimension is 8mm.

L4-5 disc reveals diffuse posterior bulge with posterior annular tear and mild
broad based right paracentral protrusion, indenting ventral thecal sac and
encroaching the right neural foramen, abutting the right budding nerve root.

L5-S1 disc reveals diffuse posterior bulge with posterior annular tear and small
pocterocentral protrusion effacing the epidural fat.

Screening of pelvis reveals mild diffuse wall thickening of the urinary bladder.
The prostate is moderately enlarged. A suspicious small T2 hypointense nodule
in the left paramidline part of the gland. Suggest- further evaluation with TRUS.
Screening of dorsal spine reveals mild heterogenous marrow signal in the dorsal
vertebrae. Small T2 hyperintense lesions in D6 and D7 vertebral bodies likely to
be hemangiomas. Few schmorls nodes in the mid dorsal vertebral bodies.

Patient Name : MEENA SINGH ID No : 190917 14

Age : 77 yrs Sex : Female

Date : 19-Sep-2017

MRI OF WHOLE SPINE

MRI of the whole spine has been performed using spin echo technique. Both T1W
and T2W images were obtained in axial and sagittal planes. In addition, whole
spine screening was carried out.

The alignment of the spine is well maintained.


There are diffusely abnormal, altered marrow signals seen involving the multiple
vertebral bodies as well as the posterior elements at multiple levels of the whole spine
and visualized pelvic bones which appear hypointense on T1W images and show
patchy intermediate to hyperintense signal on STIR images.
There is presence of an abnormal paravertebral soft tissue lesion measuring 2.4 x 1.2 x
2.4 cm (AP X TRANS X CC), seen at the level of D6 on the left side, which is involving
the left costovertebral joint and causes osteolysis of the head of the 6th rib. No intra
spinal extension is seen. There is another mildly expansile lytic soft tissue lesion seen
involving the posterior aspect of the 8th rib on the right side.
Multifocal T1 and T2 hyperintense lesions, are seen in D2, D5, D6, D8, D12, L2, L5 and
S1 vertebral bodies. There is no loss of height / erosions of the vertebral bodies. No
epidural soft tissue noted.

All the cervical discs appear partially dessicated. Mild degenerative posterior disc bulge
of C5-C6 disc is noted indenting the ventral sub arachnoid space. However, no
significant nerve root compression is seen.
Cervicomedullary junction appears unremarkable.

Craniovertebral junction appears unremarkable.

The dorsal spice shows marginal osteophytes at multiple levels and partially desiccation
of the intervertebral discs.

There is loss of lumbar lordosis.


Schmorls nodes with adjoining endplate oedema are seen involving the L3 and L4
vertebral bodies.

Degenerative changes are seen in the form of marginal osteophytes from L1 to L5 and
end plate changes at L5 and S1 levels.
Minimal scoliosis of the lumbar spine is noted with convexity to the left.
The lumbar intervertebral disc shows desiccation at all levels. There is mild reduction in
height of the L3-L4 and L5-S1 discs.
Degenerative diffuse disc bulges are seen at L2-L3, L3-L4, L4-L5and L5-S1 levels
causing indentation on ventral thecal sac and encroaching bilateral neural foramina
without causing significant compression upon the nerve roots.

Posterior annular fissuring is seen at L4-L5 and L5-S1 level.

Mild facetal arthropathy is noted at L4-L5 and L5-S1 levels. Mild Ligamentum flavum
thickening is noted from L2 to L5 levels.

The anterior-posterior spinal canal diameter at L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1
levels are 16 mm, 15 mm, 12 mm, 12 mm an 13 mm respectively.

Lower end of spinal cord, conus medullaris and filum terminale appear normal.

A small, cystic, bilobed T2 hyperintense Tarlovs cyst is noted within the canal at S2-S3
level causing mild canal compromise and encroaches on right neural foramen at S2-3
level.

Pre-and paravertebral muscles appear unremarkable.

Incidental note: An enlarged heterogeneous intensity lesion is seen in right lobe of


thyroid with minimal retrosternal extension. Another smaller nodule is seen in the left
lobe.

Minimal bilateral pleural effusion is noted.

Impression :
Abnormal altered marrow signal involving the whole spine and pelvic
bones with associated abnormal paravertebral soft tissue lesion seen at
the level of D6 on the left side, which appears to be associated with
destruction of the head of the 6th rib. In addition, another soft tissue lesion
with focal rib expansion is seen involving the posterior aspect of probably
the 8th rib on the right side. These findings raise the suspicion of a
neoplastic process like metastases, which requires histopathological
correlation. Another differential includes multiple myeloma which cannot
be completely ruled out.

Multifocal T1/T2 hyperintense lesions, seen in D2, D5, D6, D8, D12, L2, L5
and S1 vertebral bodies probably represent hemangiomas.

Degenerative age related changes in entire spine as described above in the


text.

An enlarged heterogeneous intensity lesion is seen in right lobe of thyroid


with minimal retrosternal extension. Another smaller nodule is seen in the
left lobe. This requires further evaluation with USG / CT with
histopathological correlation.

Minimal bilateral pleural effusion.

Dr. Raj Koticha Dr Karuna Agawane


DMRD, DNB DMRD, Fellowship in CT/MRI

Degenerative changes are seen at C4-C5 and C5-C6 levels in the form of reduced
intervertebral disc height and osteophytic changes. Due to reversal of lordotic curvature,
there is partial effacement of the ventral thecal sac. Uncinate hypertrophy seen
bilaterally at these levels causing narrowing of the neural foramina however no
significant nerve root compression is observed. There is no compression upon the
spinal cord.

There is evidence of erosions with irregularity and altered marrow signal intensity of the
D5 vertebrae, which appear hypointense on T1W images and hyperintense on
T2W/STIR images. There is anterior wedging with partial collapse of the D5 vertebrae
with minimal retropulsion obliterating the ventral subarachnoid space and compressing
the spinal cord at these levels. How,ever no intrinsic cord abnormality is noted. The
D10-11 intervertebral discs also show altered signal intensity. In addition there is
evidence of abnormal anterior episural soft tisse extending from D5 to D6 levels.
Anterior prevertebral and bilateral paravertebral soft tissue also noted extending from
D5 to D6 levels. On intravenous injection of contrast, there is heterogenous
enhancement of the D5 vertebrae and D6 intervetebral discs with rim enhancement
noted in the anterior epidural, prevertebral and bilateral parabvertebral regions.

There is evidence of a large, peripherally enhancing left psoas abscess measuring x x


(APX TRANS X CC), with presence of septations within. It is seen to displace the kidney
superiorly.
MRI of the neck was performed using T1 and T2 weighted sequences in multiple
planes, using a quadrature head
coil.
There is a multilocular predominantly T2 hyperintense cystic lesion with hypointense
septations seen in the left
lower neck region. The lesion is located predominantly in the subcutaneous and
intermuscular plane posterior to the
sternocleidomastoid muscle and medially a small portion insinuates into left carotid
space. The lesion is
hyperintense on T1 weighted images probably due to high protein content rather than
internal bleeding.
The entire lesion measures approximately 5 x 2.7 x 5.2 cm in anteroposterior,
transverse and craniocaudal axis.
Multiple subcentimetre sized lymph nodes are seen bilaterally at levels Ib and II.

Mucosal thickening is seen in both


maxillary sinuses.
Incidentally noted is a butterfly vertebra at D5.
The tongue base and valleculae appear normal. The visualized naso and oropharyngeal
structures reveal no obvious
abnormality. The hypopharyngeal and laryngeal structures appear normal. The
epiglottis, preepiglottic region and
the pyriform sinuses appear normal.
The supra and infra hyoid neck spaces appear normal. The neurovascular structures
formed by the jugular vein and
the carotid artery appear normal.
Bilateral parotid and submandibular glands appear normal.
IMPRESSION:
MR scan reveals a multilocular predominantly T2 hyperintense cystic lesion with
hypointense
septations seen in the left lower neck region. The lesion is located predominantly in the
subcutaneous
and intermuscular plane posterior to the sternocleidomastoid muscle and medially a
small portion
insinuates into left carotid space. Possibility of benign cystic lesion like third branchial
cleft cyst can
be considered. Clinicopathological correlation is recommended.
Multiple subcentimetre sized lymph nodes are seen bilaterally at levels Ib and II.
Mucosal thickening is seen in both maxillary sinuses.
Incidentally noted is a butterfly vertebra at D5.