L5/S1 endplate osteomyelitis/diskitis with epidural abscess
Low back pain for 2 weeks, fever of 38.5C, CRP >400.
MRI lumbar spine
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Epidural "mass" behind S1 body. Mass is T2 hyperintense but less than CSF. Note T2 hyperintense soft tissue swelling anterior to vertebral bodies and increased T2 signal in the L5/S1 disc. Peripheral enhancement of epidural mass means abscess, not just phlegmon. Note enhancement anterior to the bodies and in the L5 vertebral body means inflammatory mass rather than pus.
Bone erosion and increased T2 signal in the left anterior body of L5 entering the prevertebral soft tissues; represents the primary site of infection/osteomyelitis in the endplate.
Classic case of left anterior endplate osteomyelitis at L5 that has entered the L5/S1 disc space and then into the epidural space, extrinsically compressing the thecal sac as well as anteriorly into the prevertebral soft tissue.