Case contributed by Ammar Haouimi
Diagnosis almost certain


Severe low back pain.

Patient Data

Age: 55 years
Gender: Male

Narrowing of L5-S1 disc space with a low signal T1, high signal on T2 and STIR of the L4, and L5 vertebral endplates with enhancement on postcontrast sequences indicating bone marrow edema. Thickening with enhancement of the pre-and paravertebral spaces as well as the anterior epidural space, containing small abscess formations. A mass effect is noted on the thecal sac which is displaced posteriorly.

A small right paracentral disc prolapse is noted at L4-L5.

Case Discussion

The MRI features are consistent with an L5-S1pondylodiscitis with small abscess formations.

MRI is the imaging modality of choice due to its very high sensitivity and specificity. It is also helpful to differentiate between pyogenic, tuberculous, and fungal origin, and to rule out a neoplastic process.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.