Question: mass calcification in the sacrum

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RE: XXXXXXX XXXXXXX D
DOB: March 09,1936
MRN: 0000
Enc #: 0000
Exam Date: August 01, 2013
Fusion screws from anterior approaching spanningL4-5
spacers are present at the intervening disc spaces.
Alignment of the lumbar spine is normal.
Bone marrow signal is within normal limits.
Redemonstrated is a calcified low intensity mass measuring 3.9 x 1.5 x 3.0 cm in the central sacrum best seen
on sagittal series 3.0 cm in the central sacrum best seen on sagittal series 3 image 12 and axial series 9 image
12. This was present as far back as a CT abdomen and pelvis dated 0000 where it had a peripherally
calcified appearance and caused chronic-appearing enlargement of the lower sacral neural foramina and smooth
scalloping of the posterior sacral margin. Etiology is unclear, however, given the stability from 2009, it is a
benign lesion. Considerations including postsurgical change, calcified benign schwannoma, and other
etiologies. No edema. Posterior laminectomy change is seen at Ls--anaT4.
Evaluation by levels is as follows:
Ll-22 Normal.
L2-32 Normal.
L3-42 Mild facet arthropathy. No spinal canal or neural foraminal stenosis.
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SAMARITAN IMAGING
258I SAMARITAN DR, STE IOO
SAN XXXXXXX CA 95124
Phone: 408-358-6881
Fax: 408-356-8785
EXAM: MRI LUMBAR SPINE WITHOUT CONTRAST
HISTORY: Numbness in GU area. Low rectal tone. Subacute time course. History of back surgery 08/11.
No gadolinium per ordering MD, no recent labs.
REPORT:
TECHNIQUE: MRI of the lumbar spine on a 1.5 Tesla MRI scanner. Sagittal Tl, sagittal STIR and T2, and
axial proton density andT2 images were obtained.
COMPARISON: Comparison to MRI of the lumbar spine 05/24lll and CT abdomen0000.
FINDINGS: XXXXXXX Chern MD
455 O'Cdnnor Dr #210
San XXXXXXX CA 95128
and L5-S1 are present. Intervertebral body bony
Printed: 8/30/2013 7:36 am XXXXXXX XXXXXXX D (Exam 0000) lffilmmffi,?I.s,rr.';c
RE: XXXXXXX XXXXXXX D
DOB: March 09,1936
MRN: 0000
Enc #: 0000
Exam Date: August 01, 2013
SAMARITAN IMAGING
258I SAMARITAN DR, STE 1OO
SAN XXXXXXX CA 95124
Phone: 408-358-6881
Fax: 408-356-8785 XXXXXXX Chern MD
455 O'Cdnnor Dr #210
San XXXXXXX CA 95128
L4-5t Anterior fusion and posterior laminectomy change. No spinal canal or neural foraminal stenosis.
LS-SI: Anterior fusion and posterior laminectomy change. No spinal canal stenosis. Mild right neural
foraminal stenosis.
An incidentally noted left-side perineural neural foraminal nerve root cyst is seen atTll-I2.
IMPRESSION:
l. Stable appearance of a 1.5 x 3.9 cm calcified mass posterior to the sacrum which is unchanged from 2009
at which point it caused chronic appearing scalloping of the posterior sacral margin as well as widening of the
neural foramina. No actively suspicious features are seen. This is most likely benign given the stable
appearance from 2009. Considerations include postsurgical change, calcified meningioma, or other etiologies.
This does not cause visualized spinal canal stenosis or impingement upon the adjacent sacral nerye roots.
2. Anterior fusion hardware from L4-5 and L5-S I without hardware complication. Posterior iaminectomy
changes atL4 andLl.
3. L3-A:Mild facet arthropathy. No spinal canal or neural foraminal stenosis.
4. L4-Sz Anterior fusion and posterior laminectomy change. No spinal canal or neural foraminal stenosis.
5. L5-Sl: Anterior fusion and posterior laminectomy change. No spinal canal stenosis. Mild right neural
foraminal stenosis.
Thank you for the opportunity to participate in the care of this patient.
Willis Huang, MD
Board Certified Radiologist
Electronically Signed: 8l2l13 l:24 pm
YG Transcribed: 812/13 12:30 pm
CC: XXXXXXX Rustamzadeh MD
The information contained in this facsimile message is privileged and confidential information intended only for the use of the individual or entity named as recipient. If the
readerisnottheintendedrecipient,beherebynotifiedthatanydissemination,distributionorcopyofthiscommunicationisstrictlyprohibited. Ifyouhavereceivedthis
communication in eror, please notifu us immediately by telephone and retum the original message to us at the above address via the U.S. Postal Service. Thank you!
Printed: 8/30/2013 7:36 arn XXXXXXX XXXXXXX D (Exam 0000) Page 2 of 2

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VRI Samaritan
2581 Samaritan Drive, Suite 100
San XXXXXXX CA 95124
Phone: (408) 358-6881
Fax: (408) 356-8785 XXXXXXX XXXXXXX Exam requested by:
MRN: 0000VR1 XXXXXXX $HIRZADI MD
DOB: 03-09-1936 Sex: F 2577 SAMARITAN AVE, STE 710 Phone:0000 SAN XXXXXXX CA95124
Date of Service: A4-O5-2O14
Exam: MR sacrum coccyx wo [7219sscj- pelvis FAX: (408) 358-8134
EXAM: MR SACRUM COCCYX WITHOUT CONTRAST
HISTORY: 7B-year-old woman rvith history of pain.
TECI{NIQUE: MRIsacrlurona I.5Teslamagnetwithoutcontrast: AxialTl ,axial S'IIR,sagittal 'l'1,
sagittal STIR, coronal
-l'1,
cororral STIR.
COMPARISON: Con'elated with CT dated 0000 cornpared to prior MRI lumbar spine dated
08/01/20 i 3.
FINDINGS:
The knor.vn heterogeneous calcified mass centered on the sacrum is similar in size and appearance when
comparedtothepriorstudies. J'hislesionmeasuresapproxinrately3.9x l.Tcnronaxial intages.and3.gcm
cratriocaudally. 'l"he lesion continucs to scallop thc margins of the sacrulrr and neural lbrar-rrina. ,Along tlre upper
aspect of this lesion. metallic sLrsceptibility artif-act fi'om patient's knolrr lunrbar sacral hardware is noted
obscuring visualization. 'flre extrafbraminal sacral nerve roots appear u'ithin norrlal linrits rr,ithout cvidcncc of'
inrpingirrg lesions.
Other than the abnormal sacral lesion and lumbar sacral postsulgical changes, no other acute sacral finding is
seen. SI joints are rvithin norrnal limits.
IMPRESSION:
1. Similar appearance of expansile heterogeneously calcified lesion centered upon the sacrun.
2. No acute sacral or Sljoint finding is seen.
End ofdiagnostic report for accession: 234611
Dictated: 4i7tZA14 9:00:41 AM
Dictnted Ily: Kuo, Michaei MI)
'I'ranscritred By: KA 4/8i2014 10:04:37 AM
Signed By: Kuo, MichaelMD 4/8/2014 11:08:00 AM
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Patient: XXXXXXX XXXXXXX DOB: 03-09-1936
Confidential