Gossypiboma - paraspinal

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Had surgery for disc herniation at L4-L5 two months ago, presented with fever and low back pain.

Patient Data

Age: 60 years
Gender: Male
mri

Well-defined ovoid structure of left paraspinal location at L4-L5 level displaying a low signal on T1, heterogeneous high signal on T2 centrally with a peripheral rim of high signal on T1, low signal on T2. The postcontrast sequences show a peripheral thick ring-like enhancement as well as enhancement of the paraspinal muscles and adjacent subcutaneous fatty tissue (postoperative scar). L5 laminectomy is noted.

ultrasound

Arciform echogenic structure with intense posterior acoustic shadowing is noted in the left paraspinal region.

Case Discussion

The MRI and ultrasound features in a patient with a history of surgery are most consistent with an infected foreign body (gossypiboma), that was confirmed at surgery.

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