Hi, guys! First post in this group. For the last few months, I've been having tests done for a potential CSF leak (brain CT and MRI revealed intracranial hypotension with all the classic symptoms of a leak). I present many symptoms of a leak ie- brain stem sag, posterior fossa crowding, low laying tonsils. I got my spine MRI results back and there was no leakage. In fact, there was nothing except low laying tonsils. However, my brain MRI/CT indicated a bunch of sinus issues. CT was on March 14th- Mild mucosal thickening involving the paranasal sinuses. The mastoidair cells are clear
Mri was on March 29- Mucosalthickening of the maxillary sinus ethmoid sinus and frontalsinus. Heterogeneous T2 signal with restricted effusion inthe region of the pharyngeal tonsils. No enhancingcollection to suggest abscess. Increased signal within the pharyngeal tonsils, likelyinfectious/inflammatory. I was not ill when these were taken. I still dont feel ill. If anyone would like to see images, let me know.
The neurologist noted that I have lost the curvature of both the spine and cervical and diagnosed me with cervicogenic headaches. Also some herniated discs in the thoracic region (T4-T6) and some bulging in the neck (C6-C7). He says there is also reduced flow in the R neck and has requested i do a CT angiogram for the head + neck to rule out any torn vessels. Right after this appointment, I did some blood work and said blood work revealed that my ferritin is very low (at a 10). Funny enough, I have been in contact with Linda Leithe from Duke and she says I present with a partially empty sella and tonsillar ectopia...she thinks my brain is in HIGH pressure. I have had MULTIPLE diagnoses and i am so stumped. I've seen my MD, a neurologist, optometrist, getting referred to a neurosurgeon, ENT and an ophtalmologist. I have done a brain CT (with con), spine and brain MRI, CTA for head and neck.
I'm wondering if anyone has some insight on this. My doctor thinks my iron is fine and shouldn't impact me. My neuro thinks the neck is certainly a contributing factor, but didn't mention IIH at all. My optometrist says my eyes are fine (seeing him again today). I feel like an incomplete puzzle and want these sudden symptoms to go away :(
At the moment, my symptoms are as follows:
Headaches and VERY stiff neck
Ear leakage (often) and the pressure in my R ear is INSANE.
R lymph node has been swollen for awhile, is slightly tender.
Tinnitus (sometimes a pounding so loud my heart feels like it will come out of my ears, at other times, just ringing)
Dizziness/blurry vision (also black dots in my vision occasionally)... the blurry vision is AWFUL and is very bad in the mornings.
Shortness of breath
Pins and needles sometimes into my whole arm, often just the finger tips.
Blood pressure has risen
Palpitations and chest pain (went from severe to very very mild)
I am a 33 year old active female. I have always had back pain and "slipped ribs".
Here is the spinal report (but the radiologist missed a lot according to my neuro). I have also attached a photo.
Alignment is normal. Spinal cord has normal signal and morphology. No spinal longitudinal extradural collection fluid.
Vertebral body height and marrow signal is preserved.
Spinal canal is capacious. At T4 and T5-T6 there are moderate left paracentral posterior disc protrusions which cause mild to moderate indentation of the anterior thecal sac. No abnormal cord signal.
There is no mild to moderate face osteoarthritis in the lumbar spine.
*The radiologist noted that there is NO mild to moderate facet osteoarthritis in the lumbar spine.... is this an error? I feel like it wouldn't even be mentioned if i didn't have it.
Conus terminates appropriately at L2.
No paraspinal soft tissue abnormality.
Any feed back is appreciated!! Sorry for the long post. <3

HISTORY: LUMBAR STENOSIS WITH NERUOGENIC CLAUDICATION, POST LAMI TECHNIQUE: MRI of the lumbar spine was performed with and without contrast

FINDINGS: The conus medullaris terminates at L1-L2. There is enhancement of multiple cauda equina nerve roots at the level of L3-4. Grade 1 anterolisthesis at L3-L4 and mild retrolisthesis at L4-L5. No loss of vertebral body height or acute displaced fracture. Moderate to severe loss of disc height at L4-L5 with reactive edematous endplate changes and endplate enhancement. There is enhancing tissue in the midline cervical soft tissues, right paracentral paraspinal musculature, extending into the right L3-4 laminotomy site. In the dorsal epidural space, there is enhancing tissue which measures up to 6 mm in thickness. There is additional circumferential epidural enhancement at L3-L4. Paraspinal soft tissues are unremarkable. Review of the axial images demonstrates the following: T12/L1: No canal or foraminal narrowing. L1/L2: Mild facet hypertrophy. No canal or foraminal narrowing. L2/3: There is a 2 mm disc bulge. Mild to moderate facet hypertrophy. Mild epidural lipomatosis. The thecal sac is moderately narrowed to 9 mm AP. Moderate and mild left neuroforaminal narrowing. There is mild associated thecal sac narrowing to 8 mm AP. Moderate bilateral neuroforaminal narrowing. L3/4: Postoperative changes. There is circumferential epidural enhancement with more focal enhancement in the dorsal epidural space resulting in mild thecal sac narrowing to 8 mm AP. Mild right and moderate left neuroforaminal narrowing. L4/5: Disc bulge with superimposed broad-based posterior disc protrusion which measures up to 6 mm. Mild facet hypertrophy. Ligamentum flavum hypertrophy. The thecal sac is severely narrowed to 5 mm AP. Severe bilateral neuroforaminal narrowing. The disc contacts the bilateral descending L5 nerve roots. 

EXAMS: CPT CODE: 002396523 MRI L-SPINE W/WO CONTRAST 72158

 L5/S1: No canal or foraminal narrowing. IMPRESSION: 1. Postoperative changes at L3-L4 with right-sided laminotomy. 2. There is enhancing soft tissue along the surgical tract with circumferential enhancement of the epidural space at the level of L3-L4 and more focal involvement of the dorsal epidural space measuring up to 6 mm in thickness with associated mild thecal sac narrowing, which is favored to be due to postoperative granulation tissue but cannot exclude superimposed phlegmon. No drainable fluid collection. 3. There is associated enhancement of the cauda equina nerve roots at L3-L4, favored to be due to postoperative changes although in the correct clinical setting, recommend correlation for symptoms of arachnoiditis. 4. Disc bulge with superimposed broad-based posterior disc protrusion at L4-L5 with severe thecal sac narrowing, contrast with the descending L5 nerve roots in the lateral recesses, and severe neuroforaminal narrowing. 

I have pain and lump (or swelling?) of some kind on my lower leg, just above the sock line in this image. It does ache, almost a burning pain. I feel it up into my thigh and groin as well. I went to urgent care where they did an ultrasound of the entire leg and also had a d-dimer, both came back negative for clot. No fluid, abscess, or growth seen either. Ultrasound tech was thinking muscle or ligament. Dr really had no clue and threw antibiotics and a fungal cream at it. I do have low grade venous insufficiency (1.6 seconds) in the Great saphenous insufficiency and the femoral valve and also some documented denervation seen at the paraspinals on an EMG. Anyone ever seen this? Lots of twiching, bugs crawling under skin sensation on the lower leg. It really doesn't get too red or anything, it's just uncomfortable, painful, leg tense, and tender.
Leg lump just above sock line.

Fair warning, this is gonna be a long post. Happy ending though!
I’ve been here a few months now, and I feel obligated to give back and report on how things are going for me so that maybe I can help someone else on their journey like so many others have helped me on mine.
I’ve made other posts before mentioning the beginning of my butt problems, but here be a more detailed rundown:

Beginning of August 2023 -

• Had a gnarly bm at work, and of course the tp they have there is literal sandpaper. I like to make sure I’m spotless Down Under so I absolutely annihilated my butthole in an effort to achieve sparkly cleanliness. I immediately knew I overdid it cuz of how bad my bh was stinging but I figured it would clear up in a day or two.

I have learned a valuable lesson from this and I cannot stress this enough: DON’T MAKE THIS MISTAKE. USE WETS WIPES AND A BIDET. Standard tp is VERY unforgiving. If you do use tp, don’t aggressively rub, gently dab.

• A few days pass and the pain worsens. I have another bm, lots of blood but relief. I’m unsettled but move on with my day. My instincts were telling me something doesn’t seem right but I wanted to see if time would heal me.
  
• I notice some little pus spots in the following days when I dab with tp, which immediately put me on high alert. I look back there with a mirror and see a little pimple looking thing very close to my anal opening. I’m alarmed but decide to give it another couple days to see if it went away on it’s own. Spoiler alert: it didn’t.
  
• I go to local urgent care, and as is the trend in this sub, I get misdiagnosed with having an ingrown hair and given antibiotics. Also told to do sitz baths and hot compresses to help it drain. The meds helped shrink the pimple and it went nearly flat, but after the course was finished, that “pimple” came back with a vengeance and turned into a proper abscess. It filled up and abscessed over the course of about two days.
  
• Woke up for work and had trouble walking and sitting. I immediately knew what was up thanks to having thoroughly explored this sub by this point, and educated myself on what I likely had going on. The urgent care had told me to follow up with general surgery if I had continued problems, but l knew to go right to a specialist. Thankfully my insurance doesn’t require referrals. Through an insane amount of luck and perhaps some divine intervention, I was able to see a CRS the same day I woke up with the abscess. Bedside I&D with local anesthetic, and it hurt BAD. Immediately relieved of abscess pain though. CRS checked for fistula at this time too, but did not see anything. I was hopeful the I&D would be the end of this for me. (Spoiler alert x2: it wasn’t.)
  

September to October 2023 -

• Went in for follow up with CRS at two weeks from I&D. Still having minimal pus and blood drainage, so I’d been keeping gauze tucked between my cheeks all this time. I was hoping against hope I was just healing slowly. He took one quick look and immediately decided that things didn’t seem right. Gave me the option of EUA with possible fistulotomy vs. seton placement OR I could try to live with things. I decided on surgery knowing the quicker you tackle fistula, the better. I didn’t want it getting worse or risk branching off. Scheduled for surgery end of October ‘23. I was devastated this wasn’t over with, and kept thinking about putting things off til I had more savings and better insurance next year - but I eventually made my peace with things. I didn’t want to suffer any longer than I already had. Health and happiness is WAY more important than money.
  
• I&D site never healed properly during entire wait time. Abscessed again twice, burst on it’s own. Kept it draining with sitz baths and religiously kept it cleaned. Lived with gauze between my cheeks 24/7. Constant drainage of blood and/or pus (yellow, green, brown). Carried my “butt kit” everywhere, which was a pack of baby wipes, some 4x4” gauze sponges, and a handheld bidet. One of my biggest recommendations is investing in a portable bidet for cleaning up after bm’s in public, get one off Amazon! LIFESAVER.
  
• The worst part of the interim between that follow up and my surgery date was honestly the waiting. Not knowing how bad it actually was back there, seeing various amount of drainage every day, varying levels of pain, the frustration of how much time it takes to clean myself up after bm’s. The mental aspect of this condition is truly debilitating. PLEASE make sure to take care of yourself and be kind to yourself as best you can. Make sure you have a support network you can talk to. Do things you enjoy. And for the love of all things, DON’T doom scroll this sub or the internet at large. Although it helped me educate myself and the positive stories were reassuring, I definitely messed up my mental state getting worked up over worst case scenarios.
  

October 27, 2023 -

• Surgery day! Everything went SUPER well, I could not be more thankful for my outcome. CRS was so chill and kind, answered all my Qs pre and post op. Woke up to find out it was a very superficial fistula, barely any sphincter involved, and got a fistulotomy! (CPT Code 46270). CRS said specifically that as far as depth of cutting required, “only a few sheets of paper” deep. I’m feeling quite good. Bleeding of course, but not terrible. Was prescribed narcotic pain meds but haven’t used them yet. Pain 1/10 for now.

UPDATE 1 - October 28, 2023 -

• Still feeling decent, but I can feel the soreness intensifying today. I reckon it’ll be even worse by tomorrow, but we shall see. Bleeding continues but seems lighter. Spent nearly all day sleeping yesterday when I got home from the hospital, and I plan on relaxing in bed all day today as well. Making sure to keep pressure off the booty so I’m laying on my sides or angling onto one of my butt cheeks if I’m on my back.

UPDATE 2 - October 31, 2023 -

• Happy Halloween! Still hangin’ in there. Drainage is about the same volume wise, but it’s more pink and clear-ish fluid than blood now. Had my first bm’s today. (I typically poop every 2-3 days so I wasn’t too stressed about how long it’s been since surgery day.)
  
• It definitely sucked and I was a bit backed up, so my first bm was a bit hard and on the smaller side. Pain was maybe 4/10 during and right after passage, and gradually subsided within an hour to a 1/10. Minor bleeding. Took milk of magnesia in the morning to encourage a proper bm, which I finally passed in the afternoon. This one was a bigger bm and hurt quite a bit more, 6/10, lingering pain afterwards that gradually decreased to a 2/10. Used handheld bidet to clean up, NO tp whatsoever. Dabbed with a wet wipe to make sure I was clean. Took an extra long sitz bath (15min) right afterwards which really helped calm the pain.
  
• As far as what my pain feels like, it’s a combination of stinging and soreness, mostly an achy sore feeling though. Post bm, it’s radiating from my butthole out into my buttcheeks and toward my tailbone a bit. I have a very high pain tolerance so it’s manageable. I’ve been sticking to Tylenol.
  

I still have no idea what the actual wound looks like, I have zero interest in finding out right now lol.

UPDATE 3 - November 6th, 2023 -

• I am now officially a week and some change out from my fistulotomy. The past week definitely had it’s ups and downs both physically and mentally.
  
• I did wind up taking one of my narcotic pain meds on day 4 and 5 due to lingering pains from a bm. Pain started subsiding a bit by later in day 5 and into day 6, but intensified a little on day 7-8. BMs still hurt quite a bit but not nearly as awful as the first one post op. Warm soapy sitz baths have been my absolute best friend to help with any pains back there. I also have a detachable shower head for further rinsing and cleaning after all of my sitz baths.
  
• Drainage overall seems to be reducing, and I’m seeing less blood. There’s a bit of a light yellow goopy substance mixed with the blood when I check my gauze now. I’m not worried about it as it does not smell and seems to be a normal part of the healing process for fistulotomy wounds according to my research. Obviously my CRS will have the final say. My follow up appt is on the 16th.
  
• I walked around for a few hours at a local bacon festival with family yesterday, which was some much-needed fun, but I definitely went a bit overboard with walking and was a tad sore afterward. Very manageable pain though. I will definitely regret eating the amount of bacon that I did but YOLO.
  
• I try not to allow myself to think too much about all this, but it’s still hard contending with the feeling that my body betrayed me and the healing process will be long and not linear. I keep reminding myself that this is a journey, not a race, which helps recenter my mindset.
  

I’ll post more updates as I make further progress! Hang in there everyone, we’ll be ok. 🤘🏻
I’ve added some extra notes below in case anyone finds them helpful.

Diet, Hygiene, and More -

• I’ll admit that my appetite was horrible for the duration of me dealing with this condition. I didn’t eat much and did a LOT of fasting because I was afraid of having bm’s. I highly recommend not doing this to yourself. I felt fatigued constantly.
  
• Post-op diet is high fiber and generally healthful. CRS said I could resume my normal diet immediately, minus spicy food and alcohol. I’m making the personal choice to eat healthier on my own. I’m eating a lot of soups, whole grain toast, plain skyr yogurt with granola, bananas, apples, etc. Basically anything easy to digest but also full of nutrients.
  
• Colace stool softener is great and I highly recommend using it pre and post op! Milk of Magnesia is also very good to help get post-op bowels moving.
  
• Make sure you keep your butt super clean and dry at all times pre AND post op, and if you have an external opening with a pre-op fistula, change your gauze every time you use the bathroom. I would wash back there every night with my removable shower head and some gentle castile soap (I use Dr. Bronner’s brand). Make sure whatever soap you use is UNSCENTED, soaps with scents in them could cause unnecessary irritation.
  

MEDICAL CODING Medical Coding is the process of conversion of a patients diagnosis, treatment received and procedures and more into alphanumeric codes. These codes must be accurate as they are sent to insurance companies to claim insurance for payment purposes. Medical Coders generate these codes with the help of taking reference from the physicians notes, lab reports, test results and more. Medical Coders use a set of previously assigned codes for coding purposes. These codes include, ICD, CPT and HCPCS codes. ICD codes or International Classification of Diseases are set of diagnostic codes, while CPT codes or Current Procedural Terminology is a set of codes used to denotes the procedures done during a healthcare services. HCPCS codes or Healthcare Common Procedural Coding System is a set of codes denoting the equipment used during a healthcare procedure. For instance ICD Code, L03.213 denotes Periorbital Cellulitis, an infection of the eyelid or skin around the eye. The most common bacterial causes of periorbital cellulitis are Staphylococcus aureus. The treatment most often includes antibiotics given through a vein. Surgery may be needed to drain the abscess or relive pressure in the space around the eye. In general cellulitis appears res, swollen and painful area of skin that is warm and tender to touch. It is not necessary to learn all the medical codes by heart since it will be open book exam. Transorze Solutions provides highest quality training in HBPO (medical coding, medical scribing, medical transcription), Australian Medical coding, Digital marketing and OET course. Transorze aims to enhance job readiness and employability in youth by providing them with training in skill development programs. Transorze Solutions provides Medical Coding and Billing Training in Trivandrum.

Can someone read over the report for me and explain? I'm not sure if I'm understanding it correctly. I think it's saying something about the ligaments in my spine? Or they're swollen and inflamed?
PROCEDURE INFORMATION: Exam: MR Thoracic Spine Without and With Contrast Exam date and time: 1/12/2023 1:56 PM Age: 54 years old Clinical indication: Condition or disease; Prior surgery; Surgery date: 1-6 months; Surgery type: Avm removal from spine (10/26/22); Patient HX: S/P avm removal from spine (t9-l1) on 10/26/22. Continued pain and numbness on left side of back-goes around to stomach; Additional info: Other specified congenital malformations of circulatory system
TECHNIQUE: Imaging protocol: Magnetic resonance imaging of the thoracic spine without and with contrast. Contrast material: PROHANCE; Contrast volume: 15 ml; Contrast route: INTRAVENOUS (IV);
COMPARISON: MRI THORACIC SPINE WITHOUT CONTRAST (SRH) 2/21/2022 8:49 AM
FINDINGS: Bones/joints: Low T1 signal with enhancement of the T8 through T11 spinous processes as well as of the adjacent interspinous and paraspinous soft tissues. Fusion hardware of the lower cervical spine. Prominent enhancement is present dorsal to the cord spanning the entire thoracic spine. Spinal cord: Worsening cord signal, now present at the T5 through T6 levels, with more fluid like signal the T7-8 level where the cord appears expanded, with cord signal abnormality extending down to the level T9. There are persistent abnormal flow voids along the dorsal aspect of the lower thoracic cord. T1-T2: No significant disc disease. No significant spinal canal stenosis. T2-T3: No significant disc disease. No significant spinal canal stenosis. T3-T4: No significant disc disease. No significant spinal canal stenosis. T4-T5: No significant disc disease. No significant spinal canal stenosis. T5-T6: No significant disc disease. No significant spinal canal stenosis. T6-T7: No significant disc disease. No significant spinal canal stenosis. T7-T8: No significant disc disease. No significant spinal canal stenosis. T8-T9: No significant disc disease. No significant spinal canal stenosis. T9-T10: No significant disc disease. No significant spinal canal stenosis. T10-T11: No significant disc disease. No significant spinal canal stenosis. T11-T12: No significant disc disease. No significant spinal canal stenosis. Soft tissues: Unremarkable.
IMPRESSION: IMPRESSION: 1. Interval increase in both the extent of involvement and intensity of cord signal abnormality of the thoracic cord as above. 2. Abnormal enhancement either within or adjacent to the thoracic canal dorsal to the entirety of the thoracic cord may be infectious or inflammatory. No distinct collection is identified on the T2 weighted images, and no central area of non enhancement is present to suggest abscess at this time. 3. Enhancement of the spinous processes and paraspinal musculature may reflect postsurgical changes. 4. Persistent abnormal flow voids in the lower thoracic canal.

40/m, 6’1, 190 lbs, type 1 diabetic on both humalog and lantus.
The picture in question I took tonight is located here
I had back surgery 4 months ago, developed an infection on the right side resulting in a second surgery followed by continuous infusion IV antibiotics for 8 weeks.
After the antibiotics were nearing completion (and throughout the course) blood work was done and it indicated that I was no longer actively fighting off an infection.
Approximately 2.5 weeks after discontinuing the antibiotics I went for an MRI to confirm that the treatment was successful.
The MRI said:
“Soft issues: Myositis and edema in the right dorsal paraspinal musculature (erector spinae multifidus) with irregular peripheral enhancing abscess measuring approximately 2.1 X 1.4 X 4.0 cm. The lesion is at the L1-L2 level. This is decreased from 6.5 X 3.0 X 6.8 cm on the prior study from 5/13/2022.
IMPRESSION: Since the comparison lumbar spine MRI of 05/13/2022: 1. Persistent right dorsal paraspinal myositis with improved but persisient appearance of an intramuscular abscess at L1-L2.”
The question is - given the findings on the MRI and the current state of the scarring on my back looking a little darker - same spot as the initial infection. Is this cause for concern at this point?

40/m, 6’1, 190 lbs. Type 1 diabetic, taking insulin, a statin, zoloft, recently finished an 8 week round of IV antibiotics (Penicillin-G)
Had back surgery 4 months ago, a second surgery 2.5 months ago after developing an abscess. Area was drained, hardware from the surgery removed on the right side where the abscess had formed.
After the antibiotics, blood work seems to conclude that their is no longer an infection being fought off.
MRI shows the continuous presence of the abscess (smaller than it once was - but still visible).
The MRI noted the following:
Soft issues: Myositis and edema in the right dorsal paraspinal musculature (erector spinae multifidus) with irregular peripheral enhancing abscess measuring approximately 2.1 X 1.4 X 4.0 cm. The lesion is at the L1-L2 level. This is decreased from 6.5 X 3.0 X 6.8 cm on the prior study from 5/13/2022.
IMPRESSION: Since the comparison lumbar spine MRI of 05/13/2022: 1. Persistent right dorsal paraspinal myositis with improved but persisient appearance of an intramuscular abscess at L1-L2.
Semi related question - also included in the MRI
FINDINGS: Scout localizer: Multilevel mid and lower thoracic compression deformities are noted. including T6, T8, TI0, T11, and T12 without obvious marrow edema on the scout localizer T1 sequence. Marrow: Subacute compression deformity of L1 with unchanged height loss since the prior study. Redemonstrated subacute fracture of L2 with a prominent osséous cleft In the central region extending from the superior endplate to the inferior endplate. No new fracture identified. Redemonstrated left-sided posterior fusion at L1-L3.

• Compression deformities? Would these be considered fractures that have healed or something different? It’s the first I’ve seen any of them mentioned. With the original surgery - it was noted that fractures were seen in T9, L1, L2 and L4. Whether fracture, or just other damage - it’s a whole lot of things happening to my back.

40/m, 6’1, 190 lbs. Type 1 diabetic. Had surgeries on my back after a car accident resulting in multiple vertebral fractures.
Infection developed on one side which led to a second surgery followed by 8 weeks of continuous IV antibiotic therapy due to the infection making it’s way to the spinal bones.
Had a recent MRI to follow up now that antibiotics have been discontinued for a few weeks. This is a portion of the results.
Soft issues: Myositis and edema in the right dorsal paraspinal musculature (erector spinae multifidus) with irregular peripheral enhancing abscess measuring approximately 2.1 X 1.4 X 4.0 cm. The lesion is at the L1-L2 level. This is decreased from 6.5 X 3.0 X 6.8 cm on the prior study from 5/13/2022.
IMPRESSION: Since the comparison lumbar spine MRI of 05/13/2022: 1. Persistent right dorsal paraspinal myositis with improved but persisient appearance of an intramuscular abscess at L1-L2.
So the question is - if the abscess is still showing (but has shrunk presumably due to effectiveness of the antibiotics) - would it be recommended to go back on them, or is it within normal limits to still have it showing up on MRI at this point?

40/m, 6’1, 190 lbs. type 1 diabetic and on humalog and Lantus. Was involved in a vehicle accident 4 months ago. Had surgery and developed an infection and had subsequent second surgery with hardware being removed on the right side.
Completed 8 week round of IV antibiotics continuous infusion. Had this MRI 2 weeks after the antibiotics were discontinued to check the status. Blood work completely recently has shown no signs of infection left (at least nothing that is being fought off). It looks like according to this MRI, there may still be some lingering infection.
MRI LUMBAR SPINE WITH AND WITHOUT CONTRAST: 7/15/2022 HISTORY: Back pain for four months. Two lumbar surgeries ten weeks ago and four months ago. COMPARISON: MRI lumbar spine 05/13/2022, MRI lumbarspine 05/02/2022, 03/18/ 2022, lumbar spine 03/18/2022.
TECHNIQUE: Appropriate pulse sequences were employed in multiple planes. T1-weighted images Were obtained both before and after the intravenous administration of a gadolinium contrast agent. A 1.5 Tesla magnet was used. Total contrast administered on date of service: 8 ml Gadavist - IV.
FINDINGS: Scout localizer: Multilevel mid and lower thoracic compression deformities are noted. including T6, T8, TI0, T11, and T12 without obvious marrow edema on the scout localizer T1 sequence. Marrow: Subacute compression deformity of L1 with unchanged height loss since the prior study. Redemonstrated subacute fracture of L2 with a prominent osséous cleft In the central region extending from the superior endplate to the inferior endplate. No new fracture identified. Redemonstrated left-sided posterior fusion at L1-L3.
Alignment: Alignment is within normal limits. Conus: The conus medullaris shows normal position, contour, and signal content. There is no abnormal enhancement within the spinal canal
TI2-L1: The spinal canal and neuroforamina are patent. No facet arthropathy. LI-L2: The spinal canal and neuroforamina are patent. No facet arthropathy L2-L.3: The spinal canal and neuroforamina are patent. No facet arthropathy. L3-L4: The spinal canal and neuroforamina are patent. No facet arthropathy. L4-LS: The spinal canal and neuroforamina are patent. No facet arthropathy. L5-S1: The spinal canal and neuroforamina are patent. No facet arthropathy.
Soft issues: Myositis in the right dorsal paraspinal musculature (erector spinae multifidus) with irregular peripheral enhancing abscess measuring approximately 2.1 X 1.4 X 4.0 cm. The lesion is at the L1-L2 level. This is decreased from 6.5 X 3.0 X 6.8 cm on the prior study from 5/13/2022.
IMPRESSION: Since the comparison lumbar spine MRI of 05/13/2022: 1. Persistent right dorsal paraspinal myositis with improved but persisient appearance of an intramuscular abscess at L1-L2. 2. Unchanged height loss of the subacute compression fractures of Ll and L2. There is evolving appearance of the prominent L2 compression fracture cleft extending from the superior endplate to inferior endplate. 3. Prior left L1-L3 posterior instrumented fusion.

Hi! I’m 26F, white, live in the US, 5’7” and 160lb. Have struggled with really bad back pain and (seemingly unrelated?) GI issues for about a year now - since I was a few months pregnant - I now have a 4mo old. I’m finally getting both of these issues worked up now as it seems like it was nearly impossible to get good care during pregnancy, everything was just blamed on pregnancy.
After a clean X-ray of my back, my doctor ordered an MRI, which I had yesterday. Reading the report, it seems like it’s pretty much clean, but just want to double check what the few minor findings mean - my follow up with the doctor isn’t until August. Thanks!
Impression:
Exam: MR Lumbar Spine (C-/C+) CPT 72158
Room Description: Bay Siem Verio 3.0T
INDICATION: Low back pain. Rule out metastasis/tumor.
TECHNIQUE: Multiplanar, multisequence MRI of the lumbar spine was performed before and after the administration of 15 mL Dotarem intravenous contrast.
COMPARISON: None.
FINDINGS:
This study assumes 5 nonrib-bearing lumbar-type vertebral bodies.
Alignment is preserved. Vertebral body heights are maintained. Edema in the anterior and right lateral inferior endplate of L1 is compatible with Modic 1 endplate change. Marrow signal is otherwise preserved. Intervertebral disc spaces are maintained.
The conus demonstrates normal signal and caliber, with a normal termination at L1.
No abnormal intradural or epidural enhancement is seen.
Paraspinal soft tissues demonstrate no significant abnormality.
Findings by level: T12-L1: No significant disc herniation, central stenosis, or neural foraminal narrowing. L1-2: No significant disc herniation, central stenosis, or neural foraminal narrowing. L2-3: No significant disc herniation, central stenosis, or neural foraminal narrowing. L3-4: No significant disc herniation, central stenosis, or neural foraminal narrowing. L4-5: Minimal broad-based disc bulge with no significant central stenosis or neural foraminal narrowing. L5-S1: Minimal central protrusion with no significant central stenosis or neural foraminal narrowing.
IMPRESSION:
Degenerative endplate signal changes at lower L1. No significant stenosis, cord or nerve compression, mass, or other acute abnormality.

----Edit-----
Now I have a rash down both arms.
https://imgur.com/a/8v6FfTd
Additionally in that arm shown, I have very tender swelling that follows the vein down my arm into my wrist. The swelling is below where the IV was inserted.
_------
I have a rather complex medical issue going on right now and I could really use some help.
​
Background:
43 yr old F
History of Crohns, Abdominal Cancer, Pre-eclampsia and bowel obstruction, broken tailbone (at 17) broken spine at (19.) Hashimotos (Mild.) ADHD
Surgeries: Small bowel resection, 3 c-sections.
Medications:
Cymbalta
Wegovy (for weight loss, I have lost 70lbs in 2 years.)
Vyvanse for ADHD
No smoking or other recreational fun.
SouthEast USA.
​
I have the entire MRI read on a clickable link if someone will be willing to take a in-depth look at it and give me their feedback. I'm not looking for an official diagnosis nor would I take the feedback as medical advice.
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The Issue:
For many years I've had off and on issues with localized back pain. I've always been told to "lose weight and exercise" etc. So I followed that advice and I lost weight and exercised.
70lbs and 2 years later my back issues are 2000% worse. Not only do I have crippling waves of back pain that wave down the back of my skull/neck and then between my shoulder blades and lastly very low in the S1-2 area throughout my hip/pelvis bones, but now I have numbness in my feet.
After standing for more than a couple of minutes, tingling and numbness will start on the outside edge of my right foot from the pinky toe inward, until the entire foot is numb minutes later.
Then the numbness will spread over to my right foot in much the same manner.
Walking only exacerbates the process.
This issue has been progressive and what started out as an occasional issue, has now progressed into a daily issue.
Occasional strange "tingling" feeling in my sanitary area. I don't know how else to explain that without sounding crude. This is not arousal related.
And most recently along with all that, my major muscles in my thighs get easily fatigued and feel weak and shakey. Like riding a bicycle up a big hill and stepping off. It is an incredibly odd feeling to have that feeling in your muscles and not be winded or have your lungs burn.
Also every day something new aches or hurts. My muscles even in my arms get sore and feel bruised.
A few days ago I started running a fever. The fever is periodic and unpredictable. It's typically low grade but there are times when I will get clammy and absolutely soaking wet with sweat. So much so that my clothing will be soaked and then I have to change. Especially at night.
I had some labs done.
WBC
17.9
Neutrophils (Absolute) 12.0
Lymphs (Absolute)
3.8
Monocytes(Absolute)
1.0
Immature Grans (Abs)
0.2
SED Rate
29
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I had a MRI in February that said:

History: Low back pain radiating to the bilateral feet, progressive numbness. Technique: Complete MRI of the lumbar spine without contrast. Comparison: None available. Findings: The spine is imaged to the T12 level on sagittal sequences. There is no aggressive osseous lesion. No acute fractures. No diastatic pars defects. The signal characteristics of the imaged distal spinal cord are unremarkable. T11-12: Tiny central annular bulge. No substantial acquired narrowing of the vertebral canal or neural foramina. The neural foramina are incompletely imaged. T12-L1: No remarkable acquired narrowing of the vertebral canal or neural foramina. Shallow anterolateral disc osteophyte formation. L1-2: No remarkable narrowing of the vertebral canal or neural foramina. L2-3: No remarkable narrowing of the vertebral canal or neural foramina. L3-4: No remarkable narrowing of the vertebral canal or neural foramina. L4-5: No remarkable narrowing of the vertebral canal or neural foramina. L5-S1: No remarkable narrowing of the vertebral canal or neural foramina. Mild paraspinous and interspinous soft tissue edema. Tiny sacral perineural cyst at the S1 level. Cholelithiasis. IMPRESSION: 1. There is mild paraspinous and interspinous soft tissue edema at L5-S1. Otherwise, essentially unremarkable MRI assessment of the lumbar spine. 

Then 2 days ago I had this MRI report, I had gone into the ER at the behest of a DR friend who was worried that I might have a spinal abscess that may have been causing my fevers, sweats, chills, WBC etc.

CLINICAL INDICATION: 43 years old Female with Eval for progressive back pain, COMPARISON: None TECHNIQUE: Multiplanar MRI was performed through the cervical, thoracic, and lumbar spine prior to and following intravenous contrast administration. FINDINGS: Bone marrow signal intensity is mildly heterogeneous, likely degenerative. There are several foci of T2 hyperintense within the cord at C3-4 and C4-5, favored to be artifactual. The remainder of the cord is unremarkable and the conus medullaris ends at a normal level. There is no abnormal enhancement. The vertebral bodies are normally aligned. Multilevel disc desiccation predominantly in the cervical spine with no significant disc space narrowing. CERVICAL: At C3-4 and C4-5, there are disc osteophyte complexes with effacement of the ventral thecal sac resulting in mild spinal canal stenosis. No significant neural foraminal narrowing. No other level of significant spinal canal or neural foraminal narrowing throughout the cervical spine. THORACIC: No significant spinal canal or neural foraminal narrowing throughout the thoracic spine. LUMBAR: No significant spinal canal or neural foraminal narrowing throughout the lumbar spine. The paraspinal tissues are within normal limits. IMPRESSION: -Cervical spondylosis at C3-4 and C4-5 where there is mild spinal canal stenosis no other level of significant spinal canal or neural foraminal narrowing throughout the cervical, thoracic, lumbar spine. 

Why would the 2nd MRI not catch anything that was reported in the 1st MRI noted?
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I have an appointment with a Neurologist on Tues and an appointment with a Spinal Clinic in MAY! (Because that was the soonest available appointment. I'm on a cancelation list but who knows. I understand that things are tits up right now so I'm not angry but I am worried/sad.)
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Thoughts anyone? I'm worried because:
I have 3 young kids.
I have a history of cancer
This crap sucks because it hurts so bad and then when the numbness happens it's scary.
When I'm driving now, I can hardly press down the gas or break peddle due to muscle weakness.
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Please help?
Obi-wan... You're my only hope!

I'm taking a CPT coding class and having trouble answering this question. Help please! Amy underwent burr hole surgery for biopsy of an intracranial lesion. The surgeon, Dr. Stanley, had to perform an abscess drainage of a cyst that was found during the procedure next to the lesion. Would the drainage of the cyst be reported separately from the biopsy code?
I think that code 61150 would cover the burr hole, biopsy AND the drainage of the abscess, even if it was an incidental finding during the surgical procedure. Can someone please comment on my thoughts?

We have one provider who is the patient's PCP (patient has Georgia Mcaid) who had been observing an abscess on the patient's hand. We have one physician and one general surgeon in the practice. Within the same hour as the E/M (CPT-99212) from the physician, the patient was taken to the surgeon for a simple single I&D (CPT-10060). I guess I really have two or three questions. 1) Is it possible for both providers operating under the same TIN but separate Medicaid ID#s to bill both visits and get paid? 2) Is there a modifier that can be used to indicate separate events occurred in the same period in the same practice? 3) If they can't both be billed, which would most likely be paid? The first submission? The lowest-cost submission?
I'm inclined to think we've had a few occurrences of things like this and in each case the E/M code was the one that paid out, even in cases of commercial payors.

• Age -42
• Sex - F
• Height - 5'8"
• Race - W
• Duration of complaint - childhood/teens
• Location (Geographic and on body)- Missouri/USA, Thoracic spine
• Current medications (if any) - hydro/APAP (as needed), cyclobenzaprine, ibuprophen

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Hello, I have had ongoing, pretty much life-long issues with my back. I have had noticeable (not severe) kyphotic/scoliotic curve my whole life, with significant pain since my teens. I wore a plastic back brace between 15 yrs old - 16. (little too little, too late).
I've done yoga a good part of my adult life, chiropractic, topical pain relief, oral. I've had 3 radiofrequency ablations. First lasted almost 2 years, the second 9 months, and the third? I'm not sure it helped much at all. (last one was Nov 2018)
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2014 MRI There is normal thoracic alignment. There is subtle anterior wedging of the mid to lower thoracic vertebral bodies from the T6-T11 with mild associated increased kyphotic angulation and mild irregularity of the endplates suspicious for Schueuermann's disease. The thoracic cord is normal in size and signal. The paraspinous soft tissues are unremarkable. Degenerative disc and facet disease throughout the thoracic spine result in multilevel neuroforaminal stenosis with is most pronounced of mild to moderate degree bilaterally at T8-T9. Scattered small disc protrusions are noted without significant central spinal stenosis.

1. Findings suspicious for Schueurmann's disease with vertebral body wedging, mild kyphosis and irregularity of the endplates.
   
2. Multilevel degenerative neural foraminal stenosis which is most pronounced of mild to moderate degree bilaterally at T8-T9.
   

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And the results from my most recent MRI last month, 2019.

Impression 1. No change since prior MRI. 2. Normal central spinal canal. Persistent mild-to-moderate narrowing of the bilateral T8-T9 neural foramen and the left T7-T8 neural foramen. 3. Persistent moderate multilevel asymmetric disc degeneration at the mid to lower thoracic spine. 4. No change in chronic mild anterior wedge compression deformity of the T8 and T11 vertebral bodies.
Narrative MRI T-SPINE WO CONTRAST
Clinical Indication: Thoracic radicular pain.
Technique: Sagittal T1-weighted, T2-weighted and STIR images were acquired through the thoracic spine. Axial T2-weighted images were acquired through the thoracic spine.
Comparison: Thoracic spine x-ray of October 18, 2018 MRI of the thoracic spine March 13, 2014
Findings: There is normal alignment of the thoracic spine. There is chronic mild anterior wedge compression deformity of the T11 and T8 vertebral bodies. This was present on prior imaging studies. There is moderate asymmetric multilevel disc degeneration at the mid to lower thoracic spine. A small fat-containing hemangioma is within the T7 vertebral body. No other osseous lesions. The thoracic spinal cord is normal.
There is persistent mild-to-moderate left and right T8-T9 neural foraminal stenosis similar to prior MRI. This is secondary to facet hypertrophic osteoarthritis. There is mild-to-moderate narrowing of the left T7-T8 neural foramen secondary to facet osteoarthritis. The other neural foramen are patent. Incidental small scattered nerve root sheath cysts within several neural foramen.
The central spinal canal is patent. There is a small incidental bulging or protruding disc at the T5-T6 level.
Soft tissues about the thoracic spine are unremarkable.

I haven't spoken to my back doctor since getting these results yet. Before the MRI he suggested that I get a transforminal epidural. I believe I had one before my ablation, I don't remember it helping much. Also, I've had issues getting a cost estimate for the procedure from the hospital/insurance. (Have CPT codes, hospital says $4600 per code, insurance won't tell me their cost to me).
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So, the first line says 'No change since prior MRI, but then I've bolded a few things that I have not heard before.

1. hemangioma on the T7
2. incidental small nerve root sheath cysts.
3. small incidental bulging/protruding disc at T5-T6

From reading I know hemangiomas are rare to cause pain, but from some of the descriptions of the symptoms people do have, it does sound similar to my experience. The sheath cysts and bulged discs are 'incidental' so I'm not as concerned with these two, but yes...those are certainly new to me.
I have pain most days, and it seems to be getting worse again over the last few months. Maybe the last ablation worked for a month or two? But it was winter, and I wasn't 'that' active either.
I aim for at least 6000 steps a day. This is my pain gauge. A few months ago, I could go over 6000 without pain. But now it's can be much lower. I've had pain start at 2500 steps doing light housework. I can have pain start around 4-5000 steps if I take them in smaller batches. (not one long walk)
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Is there anything left? I've read so much about DDD and facet disease, and it's mostly about pain management and learning to live with this. But I am having a hard time accepting this. Before my pain came back from my second ablation last year, I was contemplating hiking the Grand Canyon (4.5 miles down and 4.5 back up, over 4 days). At this point, this is not a possible task, but I still have it in my mind to do it some day.
From this MRI, does anything significant stand out to you? Any thoughts or recommendations? I know the daily routine of PT, drugs and chiropractic care. I'm not looking for that kind of advice. I want some LONG term pain relief, like I initially got from my first ablation.
Thank you,
V

Hi there! Would love to get thoughts about some medical issues I've been dealing with, and want to understand why my doctor put me on antibiotics [that are only making me feel shittier]. Sorry for wall of text, trying to be thorough.
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• 30 / Female / 5'6" / 135lbs
• Caucasian
• 2+ years of dealing with health issues of unknown origin
• location: Pacific Northwest, USA
• location of issue: neck; systemic?
• known current medical issues: scoliosis [diagnosed as a child]
• only surgeries are tonsillectomy [at 21] and wisdom tooth extraction [at 19]
• current meds: ferrous sulfate, vitamin c, birth control, doxycycline, bactran

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The only past medical issues I've experienced were recurring ear infections as a child, and impacted and abscessed tonsils which had to be extracted as an adult. Otherwise, I rarely catch colds and am overall fairly healthy. I lost about 50 pounds after a breakup in 2012, but that was due to a change in diet and lifestyle. Not sure if anything physiologically had anything to do with that.
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What initially brought me to my doc last January:

• Difficulty swallowing
• swollen lymph nodes [for about a year at that point]
• allergies; allergic to molds, trees, grass, dust mites, dogs, cats

I had been previously seeing an allergist to try allergen immunotherapy shots, but my new GP nixed this treatment saying my allergies did not warrant the expensive and intensive desensitization shot regimen [my allergies are really not that bad, no need for an epi pen or anything like that, and I only use allergy meds maybe 1-2x per month, maybe more in the spring when all the plants are pollinating]. So we stopped the shots immediately. Only other interventions we've tried was an antacid which did nothing for me.
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Ongoing symptoms: intense hot/cold flashes, fatigue, night sweats, hyperhidrosis, mental fog, muscle fatigue/muscles sore to the touch, shakiness, sore hips and other joints, headaches, gastric distress, diarrea, frequent headaches, incontinence, low libido, depression, anxiety, restless leg syndrome, heart palpitations and chest pains, trouble swallowing, swollen lymph nodes, trouble staying asleep for more than 5 hours [is this a thing? feels like a thing].
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Over the past year I've seen two allergists, two ENTs, two physical therapists, a gastroenterologist, a spine specialist, a speech therapist, my GP and OBGYN. So far, they all think I'm fine. I've been told I need to "relearn how to swallow" [?!?!?!] and that my other issues are probably 'hormonal' or I'm over exaggerating and they're not that bad. I've been open with my doctors about my anxiety and the fact that I was raised by a hypochondriac... not sure if this has worked against me? I feel like shit though. I just want answers.
I've had a lot of testing over the past year as well - list goes from most recent at the top to past tests at the bottom:
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2/2019 - US SOFT TISSUE HEAD & NECK [results: "The ultrasound showed no suspicious lymph nodes, thyroid nodule has been unchanged."]
2/2019 - FERRITIN [slightly low but improving: 40 ng/mL]
2/2019 - TSH w/reflex to Free T4 [normal; 2.63 mIU/L]
2/2019 - CBC AND AUTO DIFF [slightly low MPV 9.2 fL]
10/2018 - GYN CYTOLOGY (PAP) [normal]
4/2018 - US SOFT TISSUE HEAD & NECK [results: "There was a small nodule on the thyroid. However, it had very reassuring characteristics and is too small for biopsy"]
4/2018 - FERRITIN [low; 26 ng/mL]
4/2018 - CBC AND AUTO DIFF [slightly elevated LYMPHOCYTE 43.1%; slightly low MPV 9.0 fL]
4/2018 - SCOLIOSIS SPINE SURVEY AP & LAT [results: "There is 21-degrees thoracolumbar dextroscoliosis, centered at the thoracolumbar junction. Slight positive coronal and negative sagittal balance is evident. There is no vertebral body height loss, segmentation anomaly, fracture or focal destruction. The disc spaces are maintained. There is no paraspinal soft tissue abnormality."] - I already knew I had scoliosis but haven't monitored it in years and wanted to be sure all was good.
3/2018 - SEDIMENTATION RATE [normal 3 mm/hr]
3/2018 - C-REACTIVE PROTEIN [normal <2.9 mg/L]
3/2018 - COMP METABOLIC SET [potassium in normal range 3.5 mmol/L]
1/2018 - HOLTER MONITOR (48 HR) [normal]
1/2018 - H. PYLORI AG, FECAL EIA [Negative]
1/2018 - COMP METABOLIC SET [Potassium slightly low @ 3.2 mmol/L]
1/2018 - TSH w/reflex to Free T4 [TSH normal; 2.63 mIU/L]
1/2018 - FERRITIN [low; 24 ng/mL]
1/2018 - CBC AND AUTO DIFF - normal except for slightly elevated LYMPHOCYTE reading at 46.3%
Some trends that you can't see from how the results are reported above:

• Ferritin count has been increasing [24, 26, 40 ng/mL respectively; makes sense bc I'm taking ferrous sulfate semi-regularly & eating more red meat and other foods high in iron]
• Slightly decreasing LYMPHOCYTE percentages [46.3, 43.1, 38.9% respectively]
• Slightly increasing NEUTROPHIL percentages [46.7, 50.6, 53.9% respectively]
• Metabolic tests have been normal
• Increasing PLATELET counts [250, 313, 336 K/cu mm respectively]
• Increasing WHITE CELL count [7.00, 7.52, 8.36 K/cu mm respectively]

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Am I reading too much into these counts?
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Not on above list: the gastro doc and speech therapists did an esophagram and an upper GI endoscopy on separate occasions, both came back normal.
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I saw my GP earlier this week after letting her know I had a sore under my armpit which was refusing to heal/reemerging. It was smaller than a dime, but have had sores in my pit since October that kept healing and popping back up. So my doctor prescribed topical bactran to handle that. She also prescribed doxycycline for... folliculitis? That's what she put on my report anyways.
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The bactran has worked great, the sore is gone and not itchy anymore. The antibiotics are making me feel worse, which isn't totally surprising I guess. But I don't understand why I'm even on them? That's why I'm here.
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Let me know if there's any detail that I missed or need clarity. Thanks for reading
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My L5-S1 ruptured a few months back and ended up with fusion (TLIF, small incision only in lower back). Nasty surgery but was basically pain-free around the 8 week mark. Last few weeks I started getting fuzzies down the leg and crazy back pain (worse than pre-surgery) so they recommended I get an MRI with contrast. MRI and report below:
http://www.dicomlibrary.com/?study=1.2.826.0.1.3680043.8.1055.1.20160705151323223.875708428.9608089

Exam: MRI LUMBAR SPINE WITH AND WITHOUT CONTRAST
CPT Code(s): 72158 - MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; LUMBAR GDV10 - 10 ML VIAL, GADAVIST 0.1ML
Clinical: Back Surgery, LBP
History: MRI lumbar spine without IV contrast.
Clinical indication: lower back pain, prior surgery.
Comparison: 7/20/2015, CT lumbar spine 3/15/2016, MRI lumbar spine 10/17/2014.
Technique: The study was acquired on a 1.5 Tesla magnet using the following pulse sequences: Sagittal T1, sagittal T2, sagittal inversion recovery, axial T1 and T2.
Findings and impression: The study demonstrates postsurgical changes consistent with laminectomy, discectomy, disc spacer placement and posterior hardware fusion at L5-S1, new since the prior study. Significant magnetic susceptibility artifact from metallic screw makes evaluation of adjacent osseous and soft tissues difficult. No obvious bone marrow edema. Central canal and neural foramina appear adequately patent. Lumbar lordosis is straightened. Vertebral body height, alignment and signal intensity appear normal. The central canal is adequately patent without mass or fluid collection. Conus medullaris is normal in position. The roots of the cauda equina appear unremarkable.
At L1-2 there is no significant abnormality. At L2-3 there is no significant abnormality. At L3-4 there is no significant abnormality. At L4-5 there is no significant abnormality. At L5-S1 there is no significant abnormality.
Visualized paraspinal soft tissues appear unremarkable.
Impression: New postsurgical changes consistent with laminectomy, discectomy, disc spacer placement and posterior hardware fusion at L5-S1. The central canal at the surgical and other lumbar levels is adequately patent. Neural foramina at L5-S1 are difficult to evaluate due to magnetic susceptibility artifact but appear adequately patent.

As you can see, everything is fine from the MRI. My worry is scar tissue forming around the nerve but I understand that is very rare. I just saw a doctor on this and they want me to wait a few months but it seems odd to me that I would be pain free and now back in excruciating pain after the surgery. I'm a 6'2", 160 pound, 29 year old fit male for reference. Been off painkillers since the 2 week post-op mark as they don't really work for me.