Spinal epidural abscess

Case contributed by Dr Bruno Di Muzio

Presentation

Cervical spine tenderness and MSSA bacteremia.

Patient Data

Age: 70 years old

MRI cervical and thoracic spines

Modality: MRI

There is a large posterior epidural abscess measuring 10 x 18 mm in axial dimensions (AP x ML) and extends from the level of C3 down to T4/5 level. Internally, there is a high T2/fluid signal, low T1 and peripheral rim enhancement. Associated mass effect causes severe spinal canal stenosis and compression of the spinal cord, without cord signal changes. 

In addition, there is an abnormal high signal within the C4, C5 vertebral bodies and C4/5 intervertebral disc, with abnormal enhancement in these areas. Fluid signal within the C4/5 facet joints bilaterally is suggestive of septic arthritis. 

Enhancing oedema of right paraspinal muscles involving the cervical and thoracic paraspinal muscles, predominately on the right, with multiple small intramuscular abscesses. 

Abnormal bilateral posterior pleural enhancement. 

Case Discussion

The abscess was surgically drained and Staphylococcus aureus was confirmed. 

This case illustrates a large cervical to thoracic epidural abscess extending from C3 to the T4/5 level, with associated paraspinal inflammation and small right intramuscular abscesses. This causes severe spinal canal stenosis, with cord compression. C4/5 discitis/osteomyelitis, with likely bilateral C4/5 facet joint septic arthritis.

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Case Information

rID: 47330
Case created: 12th Aug 2016
Last edited: 30th Dec 2016
System: Spine
Tag: rmh
Inclusion in quiz mode: Included

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