Spondylodiscitis

Case contributed by Dr Jeremy Jones

Presentation

Generalized abdominal and flank pain for several weeks. Normal ultrasound. Rule out renal stone.

Patient Data

Age: 10 years
Gender: Male

NG tube tip in the distal body of the stomach. Normal bowel gas pattern.

There is narrowing and irregularity of the L2/3 disc space.  Otherwise normal study.

There is very subtle hypoattenuation in the superior endplate of L3, but no significant loss of height.  Incidental calyceal dilatation in the upper pole of the left kidney (filled with contrast during the excretory phase of the study).

Pathology here is centered on the L2/L3 disc space. The disc is dehydrated and there is loss of disc-space height. The adjacent superior endplate of L3 is abnormal with high-T2 signal and contrast enhancement.

Features here are of discitis.

Case Discussion

This case demonstrates the subtle findings of discitis on a plain film and the importance of thinking laterally when reporting pediatric imaging.  Pediatric patients often present with symptoms that are atypical.

The features of discitis on MRI here are typical with disc height loss, high T2 signal and contrast enhancement. There is no accompanying paravertebral mass.

The most common causative agent is Staph aureus. In tuberculous discitis, there may be a large pre- or para-vertebral collection which is out of proportion to how unwell the patient is.

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