Epidural abscess

Case contributed by A.Prof Frank Gaillard

Presentation

Weakness in arms and legs.

Patient Data

Age: 45 years
MRI

Cervical spine

Extensive epidural collection extending from C2-3 disc space to the level of S1 (see thoracic and lumbar spine studies). This is characterized by peripheral enhancement, T2 hyperintense non-enhancing contents, and abnormal diffusion restriction. This is predominantly located in the anterior extradural space in the cervical and upper thoracic spine, in the posterior epidural space in the mid and lower thoracic spine, and circumferentially involving the epidural space in the lumbar spine.

There is compression of the cervical cord between C3 and C6. No cord signal abnormality. Further mild compression of the nerve roots of the cauda equina.

Conclusion: Extensive epidural abscess extending from C2-3 to S1. Epidural collection causes compression of the cervical cord between C3 and C6.

MRI

Thoracic spine

The epidural collection is seen spiralling around the thoracic theca, located anteriorly at the cervicothoracic junction and posterior at the lumbothoracic junction. 

MRI

Lumbar spine

In addition to the aforementioned epidural collection (see cervical spine study) there are bilateral L5/S1 pars defects and grade 1 anterolisthesis of L5 on S1. Bilateral L4-5 and left L3-4 facet joint effusions. Enhancing edema in the marrow of inferior articular process L4 and superior articular processes of L5 on both sides, as well as the left L3 inferior articular facet and L4 superior articular facet. Extension of marrow edema into the right pedicle and transverse process L4.

Extensive abnormal enhancement in the posterior paraspinal muscles extending from the level of the S1 to L3. Within this region, there are regions of non-enhancement and altered T2 signal suggesting abscess formation. Further abnormal enhancement in the left psoas and iliac this muscles. Focus of non-enhancement with altered T2 signal in the left psoas suggest abscess formation. 

Conclusion: Bilateral L4-5 and left L3-4 facet joint septic arthritis with extensive phlegmon and abscess formation in the posterior paraspinal muscles. Further phlegmon in the left iliacus and psoas muscle, and left psoas muscle abscess. 

Case Discussion

The patient went on to have surgical drainage, that confirmed macroscopic pus. Culture demonstrated methicillin resistant Staphylococcus aureus (MRSA). 

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Case information

rID: 59824
Published: 3rd Jun 2018
Last edited: 4th Jun 2018
Inclusion in quiz mode: Included

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