Age: 89
Sex: Male
Indication: Left flank and back pain
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Case #6
Findings
- T2/STIR signal hyperintensity, T1 signal hypointensity, and enhancement in the T12-L1 disc and in the majority of the T12 and L1 vertebral bodies extending into the pedicles bilaterally
- Surrounding T2/STIR hyperintensity and enhancement in the paraspinal soft tissues and superior aspects of the psoas muscles without peripherally-enhancing collection
- T2/STIR signal hyperintensity and enhancement in the left L4-L5 facet joint, the adjacent articular pillars, and in the surrounding soft tissues with multiple subcentimeter peripherally-enhancing collections in the L4-L5 interspinous ligament and posterior paraspinal soft tissues
- Epidural enhancing soft tissue at the level of L5 with a 1 cm peripherally-enhancing collection in the right dorsal epidural space at this level
- Multilevel degenerative disc and facet disease with discogenic endplate degenerative changes. The combination of broad-based disc bulges, facet hypertrophy, and ligamentum flavum thickening contribute to advanced spinal canal stenosis at L3-L4, moderate spinal canal stenosis at L4-L5, and multilevel neural foraminal stenosis, which is advanced on the right at L3-L4
- Diffusely heterogeneous marrow signal
Diagnosis
Discitis/osteomyelitis, septic facet arthritis, and epidural abscess
Sample Report
Findings consistent with left L4-L5 septic facet arthritis with associated osteomyelitis involving the adjacent articular pillars and surrounding phlegmon with intermixed scattered subcentimeter posterior paraspinal abscesses. Contiguous epidural phlegmon at the level of L5 with a 1 cm epidural abscess in the right dorsal epidural space.
T12-L1 discitis/osteomyelitis. Surrounding paraspinal phlegmon without evidence of epidural or paraspinal abscess at this level.
Multilevel degenerative changes with the combination of broad-based disc bulges, facet hypertrophy, and ligamentum flavum thickening contributing to advanced spinal canal stenosis at L3-L4, moderate spinal canal stenosis at L4-L5, and multilevel neural foraminal stenosis, which is advanced on the right at L3-L4.
Diffusely heterogeneous marrow signal, which is nonspecific and can be seen with chronic hypoxemia, chronic anemia, or various lymphoproliferative diseases.
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