Infective spondylodiscitis

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Back pain and tenderness.

Patient Data

Age: 55
Gender: Female
CT

CT lumbar spine

There is bony destructive process involving vertebral bodies and intervertebral disc spaces extending from the level of LV1 through LV3 with associated prevertebraland paravertebral soft tissue thickening.

Both psoas muscles showed central hypodensity on non-contras CT basis, larger at the right one.

MRI

MRI lumbar spine

Marked alteration of the marrow signals involving bodies of LV1 through LV 3 body showing predominantly T1 low and T2 high signals with marked enhancement after IV contrast administration.

LV1/2 and LV2/3 discs showed marked increased T2 signals with irregular opposing sub-end plates

Sizable intra-spinal anterior epidural collection is noted with marginal enhancement extending from along the posterior borders of DV11 down to the level of LV3 for about 14 cm in cephal-caudal dimension.

Pre-vertebral and bilateral para-vertebral components are also seen opposite LV1/2 and LV2/3 levels extending downwards and bilaterally implicating both psoas muscles with resultant bilateral psoas abscesses more sizable on the right side (reaching 6 cm in size)

Case Discussion

The described features are in favor of extensive spondylodisctitis epicentered at LV1 through LV3 levels with associated intraspinal epidural and bilateral para-vertebral components as well as bilateral psoas abscesses. The possibility of TB spondylo-disctitis should be considered.

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Case information

rID: 54395
Case created: 7th Jul 2017
Last edited: 17th Jul 2017
System: Spine
Inclusion in quiz mode: Included

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