Differential Diagnosis
- Single Most Likely Diagnosis
- Bilateral spondylolysis of L5 with nonunion or fibrous union: This diagnosis is most likely due to the presence of L5 spondylolyses distracted by 1 mm on the right and 3 mm on the left, with no evidence of bridging bone on either side, as seen on the CT scan. The MRI also showed abnormal marrow edema in the left pedicle and pars interarticularis of L5, suggesting a stress reaction or stress injury.
- Other Likely Diagnoses
- Grade 1 anterolisthesis of L5 on S1: This diagnosis is likely due to the presence of grade 1 anterolisthesis at L5-S1, with mild narrowing of the left neural foramen at this level, as seen on the CT scan.
- Interosseous hemangioma: This diagnosis is likely due to the presence of a 2 cm lesion in the right side of the sacrum at the S1 level, demonstrating mixed signal intensity on the T1-weighted images and increased signal on the T2-weighted images, as seen on the MRI.
- Mild disc bulging at L4-5 and L5-S1: This diagnosis is likely due to the presence of mild central and lateral bulging discs at the L4-5 and L5-S1 levels, causing slight compression of the thecal sac, as seen on the MRI.
- Do Not Miss Diagnoses
- Spinal tumor or infection: Although not likely, it is essential to consider spinal tumor or infection as a possible diagnosis, as they can present with similar symptoms and imaging findings. The presence of a lesion in the sacrum and abnormal marrow edema in the pedicle and pars interarticularis of L5 should prompt further evaluation to rule out these conditions.
- Fracture or trauma: It is crucial to consider fracture or trauma as a possible diagnosis, as the patient has a history of injury while playing soccer, and the imaging findings show spondylolysis and anterolisthesis.
- Rare Diagnoses
- Osteogenesis imperfecta: This rare genetic disorder can cause bone fragility and fractures, which may present with similar imaging findings.
- Fibrous dysplasia: This rare bone disorder can cause bone lesions and fractures, which may present with similar imaging findings.
- Eosinophilic granuloma: This rare condition can cause bone lesions and fractures, which may present with similar imaging findings.