Presentation
Back pain, bacteremia, and elevated CRP.
Patient Data
Note the local T8/T9 bone destruction of the osteomyelitis.
Discitis osteomyelitis centered in T8/T9 where it causes the destruction of the opposed endplates and vertebral body height loss. Apart from the fluid collection within the disc space, there is extensive phlegmon within the surrounding paravertebral soft tissues, as well as within the epidural space, where it causes focal narrowing of the spinal canal. No signs of epidural abscess.
CT scans post-surgical management with thoracic spine arthrodesis.
Case Discussion
This case brings typical features of discitis osteomyelitis with associated epidural phlegmon. It is important to distinguish the two main patterns of extension of the inflammatory/infective process into the epidural space:
- phlegmonous stage of infection results in homogeneous enhancement of the abnormal area which correlate to granulomatous-thickened tissue with embedded micro-abscess without a significant pus collection
- liquid abscess surrounded by inflammatory tissue which shows varying degree of peripheral enhancement with gadolinium
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