Presentation
Back ache with difficulty in walking.
Patient Data
End plate degenerative changes are seen throughout the spine. Minimal left convexity scoliosis epicentered at L2-L3. T2 and STIR hyperintense signals with post contrast enhancement is seen involving L2 inferior end plate and L3 superior end plate with fluid signal intensity in the L2-L3 disc. Pre and paravertebral enhancing soft tissue is present. Post contrast enhancement of proximal half of left psoas muscle fibers. Communicating with the disc space is a large peripherally enhancing fluid collection with air fluid levels involving right psoas muscle. Accompanying right iliacus hyperenhancement.
Incidentally detected small left kidney with thinned out cortex. Active edema of bilateral paravertebral muscles.
Case Discussion
Involvement of two adjacent vertebrae and their end plates with or without intervening disc signal changes should raise the suspicion of spondylodiscitis. Extension of inflammation into pre and paravertebral spaces results in spread to psoas muscles. In this case, it resulted in a large abscess. Tuberculosis should always be included in the differential whenever the imaging findings are disproportionately more in comparison to the clinical picture.
Case courtesy Dr Aarathy Appukuttan.
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