Imaging features are representative of T4/5 spondylodiscitis with an associated intraspinal epidural and bilateral paravertebral components. MRI is the modality of choice for reliable diagnosis and for differentiation from similar diseases. Important diagnostic signs include a T2 hyperintense signal at the intervertebral disc, end plates erosions, epidural and paraspinal abscesses and enhancement of the disc, end plates as well as the involved perivertebral soft tissues. Typically pyogenic spondylodiscitis is centered at the intervertebral disc, as in this case, and tuberculous spondylodiscitis is centered on the vertebral body.