Spinal epidural abscess
Cervical spine tenderness and MSSA bacteremia.
MRI cervical and thoracic spines
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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 edema 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.
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 diskitis/osteomyelitis, with likely bilateral C4/5 facet joint septic arthritis.