L3/4 osteomyelitis-discitis with epidural abscess

Case contributed by RMH Core Conditions

Presentation

Low back pain. Lower limb weakness.

Patient Data

Age: 62
Gender: Male

Anterior T2 hyperintense extradural collection with peripheral enhancement extends from above the imaged vertebrae to the mid-sacrum, with associated mild posterior displacement of the theca.

Hyperintensity of a markedly narrowed L3/4 intervertebral disc is on sagittal T2 fat suppressed images, within destructive change within the posterosuperior aspect of the L4 endplate. Bone marrow edema signal is noted within the L3/4 vertebral bodies.

Conclusion:

Anterior thoracolumbar epidural abscess extending from thoracic-midsacrum likely relating to discitis/osteomyelitis of L3/4.

Case Discussion

Spinal epidural abscess are is a rare but serious condition. MRI is the modality of choice for imaging and has high sensitivity and specificity for detection. Treatment is typically with surgical drainage and IV antibiotics. 

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