What is the most likely diagnosis?
Imaging appearances are highly suspicious for vertebral TB. The near normal L2/3 disc makes routine infectious discitis/osteomyelitis unlikely.
A well-defined oblique tubular lytic process extending through the L2 vertebral body with foci of ill-defined calcification. On MRI this lesion is seen to be very high T2 signal, without rim enhancement and communicating with a 6.4 x 3.5 cm right psoas collection. This collection extends through the centre of the L2/3 disc where it breaches the superior endplate of the L3 vertebral body. There is vivid contrast enhancement and abnormal signal within the remainder of the L2 and L3 vertebral bodies extending for a short distance into the pedicles of each.
No other vertebral body lesion. No canal stenosis or epidural collection identified.