Age: 40
Sex: Male
Indication: Lower back pain
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Case #8
Findings
- Abnormal T2/STIR signal hyperintensity and enhancement in the L2-L3 disc space as well as throughout the L2 and L3 vertebral bodies with severe disc space height loss and erosive endplate changes
- Additional sites of abnormal T2/STIR signal hyperintensity and enhancement in the posterior aspect of the L4-L5 disc, the posterior aspect of the L4 inferior endplate and L5 superior endplate, and in the L5-S1 disc
- Central hypoenhancement in the L2-L3 disc with posterior disc bulging and enhancing ventral epidural tissue spanning L2-L5 resulting in severe spinal canal stenosis with compression of nerve roots in the cauda equina and advanced bilateral neural foraminal narrowing at L2-L3. Phlegmonous tissue also results in mild spinal canal stenosis at L3-L4 and L4-L5 and in combination with degenerative changes results in moderate to advanced left and mild right neural foraminal stenosis at L3-L4 and moderate bilateral neural foraminal stenosis at L4-L5
- Small intermixed nonenhancing components in the ventral epidural enhancing tissue
- Extensive paraspinal T2/STIR signal hyperintensity and enhancement with peripherally enhancing collections in the bilateral psoas muscles from L2-L4, the largest of which measure 12 mm on the right and 6 mm on the left
- Moderate to advanced left and moderate right neural foraminal stenosis at L5-S1 related to facet hypertrophy
- Benign vertebral venous malformation (hemangioma) in the L5 vertebral body
- Conus terminates at L1, in normal position
- Enlarged retroperitoneal lymph nodes, likely reactive
Diagnosis
- Discitis/osteomyelitis
Sample Report
Findings consistent with discitis/osteomyelitis at L2-L3 with intradiscal abscess and ventral epidural phlegmon with small intermixed epidural abscesses. Epidural abscesses and phlegmon in combination with underlying degenerative changes result in severe spinal canal stenosis at L2-L3, mild spinal canal stenosis at L3-L4 and L4-L5, and varying degrees of multilevel neural foraminal stenosis, most advanced bilaterally at L2-L3 and on the left at L3-L4.
Extensive paraspinal inflammatory changes with bilateral psoas abscesses measuring up to 12 mm on the right and 6 mm on the left. Likely reactive retroperitoneal adenopathy.
Additional sites of abnormal T2/STIR signal hyperintensity and enhancement in the posterior aspect of the L4-L5 disc, the posterior aspect of the L4 inferior endplate and L5 superior endplate, and in the L5-S1 disc may be degenerative in etiology, but given adjacent infectious findings, these could represent additional sites of discitis/osteomyelitis.
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