Primary lumbar epidural abscess
IV drug user with Hep. C. Low back pain and fever with pain radiating into the lower limbs. Increased white cell count and raised CRP.
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Heterogenous mass in the left anterior epidural space of the lower lumbar canal showing pockets of T2 bightening with peripheral enhancement (fluid) indicative of abscess and more solid enhancing areas indicative of "phlegmon". Note no oedema or enhancement in vertebral bodies/discs apart from minor increase in T2 signal on STIR in the L5/S1 disc.
Epidural abscess in the absence of previous medical intervention is usually associated with discitis/endplate oesteomyelitis or other bone infection around the spinal canal. In this case it seems to be a primary phenomenon presumably due to haematogenous deposition of bacteria into the epidural veins.