Presentation
Back pain and tenderness.
Patient Data
There is a bony destructive process involving vertebral bodies and intervertebral disc spaces extending from the level of L1 through L3 with associated prevertebral and paravertebral soft tissue thickening.
Both psoas muscles showed central hypodensity on non-contras CT basis, larger at the right one.
Marked alteration of the marrow signals involving bodies of L1 through L3 body showing predominantly T1 low and T2 high signals with marked enhancement after IV contrast administration.
L1/2 and L2/3 discs showed marked increased T2 signals with irregular opposing sub-end plates.
A sizable intra-spinal anterior epidural collection is noted with marginal enhancement extending from along the posterior borders of T11 down to the level of L3 for about 14 cm in cephalo-caudal dimension.
Pre-vertebral and bilateral para-vertebral components are also seen opposite L1/2 and L2/3 levels extending downwards and bilaterally implicating both psoas muscles with resultant bilateral psoas abscesses more sizable on the right side reaching 6 cm in size.
Case Discussion
The described features are in favor of extensive spondylodiscitis epicentered at L1 to L3 with associated intraspinal epidural and bilateral paravertebral components as well as bilateral psoas abscesses. The possibility of TB spondylodiscitis should be considered.