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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29637
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I had an MRI Monday night. The doctor called me Weds. morning

Resolved Question:

I had an MRI Monday night. The doctor called me Weds. morning to say it showed a cyst near T10. He said it is pressing on a nerve. I've had LLQ pain since May and have had many tests, all of which showed nothing (other than a small femoral hernia). I was referred to a pain clinic, and their doctor ordered the lumbar MRI, just in case I had a disk problem. Here is the report:


HISTORY: Left lower quadrant abdominal pain and T11 left pain
distribution

TECHNIQUE: Multiplanar MR imaging of the Lumbosacral spine was
performed using a 1.5 Tesla magnet without contrast administration ,
using multiple pulse sequences, using the department's lumbar spine
protocol.

COMPARISON: October 23, 2006 MRI

FINDINGS:
BASED ON COUNTING FROM C2 CAUDALLY THERE ARE 5 LUMBAR TYPE VERTEBRAL
BODIES.

LUMBAR:
There is normal alignment of the lumbar spine.

There is mild disk desiccation signal changes at L1-L2, slightly
progressed from the previous exam.

Stable mild disks desiccation signal changes at L5-S1 with
circumferential disk bulge with superimposed central focal disk
protrusion without significant spinal or neuroforaminal stenosis.
There remains a region of high T2 signal within the posterior aspect
of the disk which may represent an annular fissure in the right
clinical setting. There is mild bilateral facet hypertrophy changes
at this level which on the right is touching the exiting L5 nerve
root.

No other significant degenerative identified in the lumbar spine.

The conus medullaris terminates at T12-L1. There is no abnormal
cord signal. No high STIR signal to suggest bone marrow edema is
identified.
There is no findings to suggest arachnoiditis.

Stable fatty replacement of the posterior paraspinal muscles.


Impression

IMPRESSION:

1.STABLE DEGENERATIVE CHANGES AT L5-S1, AS DETAILED IN THE BODY OF
THE REPORT

SUMMARY: 2-ABNORMAL, PREVIOUSLY REPORTED
I have personally reviewed the images for this examination and agreed
with the report transcribed above.


I called my doctor again today since I hadn't heard anything since Weds. My primary care doctor said the MRI report above (which I hadn't received online at that point) showed nothing about a cyst. She said she would contact the pain clinic doctor to ask him what's going on. Here is her recent message:

>>I heard back from Dr. XXX. The cyst is something the radiologists noted when he >>talked to them directly but hadn't noted in their report. He will have them addend the >>report to include this if it is significant.
>>Once we have that addendum I can refer you to neurosurgery clinic if needed.


The pain clinic dr told me Weds. that he had two radiologists look at it. Why is it not noted in the report (which was generated Tues. afternoon)? What does all this mean? The pain clinic dr had originally scheduled an abdominal wall trigger-point injection for 12/14, but Weds. he said he wanted to cancel that and instead do something to the cyst. I am worried and very confused.

Please advise how I should proceed, what this means, what specialist(s) I should be seeing, and what the L5-S1 damage means.

Thank you!
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.

Greetings Kristen.

The radiologist did not report about the cyst as the original ordering of the MRI was for the lumbar region (not the thoracic region as the cyst is at T10, which may be considered as incidental finding, if not causing any symptoms). Since your pain correlates to the cyst position, this will be now incorporated in the report. The specialist to consult would be a neurosurgeon / spinal surgeon for the T10 cyst. The cyst can be removed by a surgical procedure which will relieve the pressure on the nerve and your LLQ pain.

The L5-S1 changes are age related changes and are called degenerative changes. These are not significant and would be seen in almost 60-70% of people in your age group. If you have backache; physical therapy would be advised.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

 

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Customer: replied 1 year ago.

Thank you. So since the MRI was of the lumbar region and the finding was in the T10 disc, it was not reported? I have had terrible LLQ pain since mid-May. I've seen so many doctors about it. At times it feels very superficial, and when I went to PT, the heating pad felt terrible. For those reasons the doctors told me I must have nerve damage. I was diagnosed with an abdominal-wall neuroma. Then an ultrasound in August showed the small femoral hernia. It's been a very emotionally challenging time, because my youngest child is only 5. I've had constant pain of a varying nature since May. The pain clinic doctor told me Wednesday the cyst was at T10 and completely explains the pain in my LLQ area.


 


How dangerous are spinal cysts? Why do they form? My MRI did not use a contrast agent. Should I have it repeated with a contrast so that the doctors can be sure what they saw is truly a cyst? I have a bleeding disorder (HHT) and was worried what appeared to be a cyst was a small bleeding telangiectasia.


 


Also, since late May I have had chest and mid-back tightness on and off. I thought maybe it was anxiety, but it's gotten much tighter in the past month. At times I feel dizzy. My physical therapist said yesterday it's probably from the cyst since she told me the T10 disk is exactly where I pointed to the tightness. Is the tightness from the cyst pressing on the nerve? The pain clinic dr told me Weds. that the cyst was pressing on the nerve.


 


What are major complications of spinal/thoracic cysts?

Thank you so much!

Expert:  Dr. Arun Phophalia replied 1 year ago.
You are very welcome, Kristen.

Yes. Since the original ordered protocol was lumbar region, a cyst seen above in thoracic region was noted and mentioned to the concerned doctor but was not incorporated in the report. Since now it is understood that it is relevant; this would be reported too.

The LLQ pain and cyst are clearly correlated and it is good that a correct diagnosis is made. I can fully understand what you have undergone this whole duration while taking care of a small kid.

Most of the spinal cysts are benign (non cancerous), so this is unlikely to be dangerous. Most of the time, a repeat scan with the contrast is not necessary for the further evaluation. These are formed due to fluid leak in the membranes surrounding the spinal cord. A bleeding telangiectasia usually can be differentiated with a cyst in MRI.

The chest tightness can be due to the cyst as it causes local symptoms as well as referred pain. Still no harm in getting the pulmonary function tests and echocardiography for the heart and lung evaluation, for your chest symptoms (to be safe). The only complications of the spinal cysts are pressure on the nerves and cord which can cause pain, numbness, tingling, weakness of the affected region.

It is privilege assisting you.
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29637
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
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