L5/S1 endplate osteomyelitis/diskitis with epidural abscess

Case contributed by Dr Chris O'Donnell

Presentation

Low back pain for 2 weeks, fever of 38.5C, CRP >400.

Patient Data

Age: 45 years
Gender: Male

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.

Case Discussion

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. 

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Case information

rID: 16319
Published: 10th Jan 2012
Last edited: 13th Aug 2019
Tag: spine
Inclusion in quiz mode: Included

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