EURORAD ESR

Case 16031

Epidural abscess

Author(s)
Alonso, Jaime; Koren, Laura; Pizarro, Fernando; Ramirez, Jessie Zulay; Rico, Enrique; Martin, Patricia; Ramos, Ana.

Madrid, Spain; Email:jaimealsn2@gmail.com
 
Patient
male, 43 year(s)
 
 
  • Figure 1
    CT examination findings
     

    Spondylitis was initially suggested as possible diagnosis based on fat stranding of presacral space and bone changes at L4-L5 (Figure 1b).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Colonography CT; Special Focus: Abscess;

    Coronal CT, bone window. L4-L5 disc space narrowing, sclerosis and irregularity of the vertebral endplates and anterior osteophytes.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
  • Figure 2
    MRI findings
     

    T2-WI sagittal view of the cervicothoracic spine. High-signal fluid collection occupying the posterior epidural space (red arrow). Note anterior displacement of the dura mater (green arrow).

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    T1-WI sagittal view of the cervicothoracic spine after administration of paramagnetic contrast. Low-signal collection occupying the posterior epidural space with peripheral enhancement and internal septa occupying the...

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
  • Figure 3
    MRI findings

    T1-WI + Gd axial view of the thoracic spine. Fluid collection with rim enhancement occupying the posterior epidural space (red arrow) that narrows the spinal canal and displaces anteriorly the medulla.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
  • Figure 4
    MRI findings
     

    T2-WI sagittal view of the lumbar spine. High-signal fluid collection occupying the posterior epidural space (red arrow). Degenerating changes at the intervertebral disc L4–L5 and bone marrow changes.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    T1-WI sagittal view of the lumbar spine. Low signal collection occupying the posterior epidural space (red arrow). Degenerating changes at the intervertebral disc L4–L5 and fatty marrow replacement at the vertebral...

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    T1-WI + Gd sagittal view of the lumbar spine. Peripheral enhancement of the fluid collection occupying the posterior epidural space (red arrow). Note that the intervertebral disc L4–L5 does not show contrast...

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    T2-WI STIR sagittal view of the lumbar spine. There are no anomalies in the signal of the bone marrow suggesting osteomyelitis. Degenerating changes at the intervertebral disc L4 – L5.

     
    Area of Interest: Abdomen; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
  • Figure 5
    MRI findings
     

    T2-WI axial view of the lumbar spine. Fluid collection occupying the posterolateral epidural space (red arrow). Inflammatory changes in left psoas and paravertebral muscles (green arrow).

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    T1-WI + Gd lumbar spine axial view. Hypointense collection with rim enhancement occupying the epidural space (red arrow). Inflammatory changes in left psoas and paravertebral muscles. Collection within the left...

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
  • Figure 6
    Follow-up
     

    T1-cervical sagittal view. Complete resolution of spinal epidural abscesses.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    T2-cervical sagittal view. Complete resolution of spinal epidural abscesses.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    T1-dorsal sagittal view. Complete resolution of spinal epidural abscesses.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    T2-dorsal sagittal view. Complete resolution of spinal epidural abscesses.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    T1-lumbar sagittal view. Postoperative changes after extensive lumbar laminectomy. Complete resolution of spinal epidural abscesses.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;

    T2-lumbar sagittal view. Postoperative changes after extensive lumbar laminectomy. Complete resolution of spinal epidural abscesses.

     
    Area of Interest: Neuroradiology spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Abscess;
     
     
Spondylitis was initially suggested as possible diagnosis based on fat stranding of presacral space and bone changes at L4-L5 (Figure 1b).
 
Coronal CT, bone window. L4-L5 disc space narrowing, sclerosis and irregularity of the vertebral endplates and anterior osteophytes.
 
T2-WI sagittal view of the cervicothoracic spine. High-signal fluid collection occupying the posterior epidural space (red arrow). Note anterior displacement of the dura mater (green arrow).
 
T1-WI sagittal view of the cervicothoracic spine after administration of paramagnetic contrast. Low-signal collection occupying the posterior epidural space with peripheral enhancement and internal septa occupying the posterior epidural space (red arrow).
 
T1-WI + Gd axial view of the thoracic spine. Fluid collection with rim enhancement occupying the posterior epidural space (red arrow) that narrows the spinal canal and displaces anteriorly the medulla.
 
T2-WI sagittal view of the lumbar spine. High-signal fluid collection occupying the posterior epidural space (red arrow). Degenerating changes at the intervertebral disc L4–L5 and bone marrow changes.
 
T1-WI sagittal view of the lumbar spine. Low signal collection occupying the posterior epidural space (red arrow). Degenerating changes at the intervertebral disc L4–L5 and fatty marrow replacement at the vertebral endplates.
 
T1-WI + Gd sagittal view of the lumbar spine. Peripheral enhancement of the fluid collection occupying the posterior epidural space (red arrow). Note that the intervertebral disc L4–L5 does not show contrast enhancement.
 
T2-WI STIR sagittal view of the lumbar spine. There are no anomalies in the signal of the bone marrow suggesting osteomyelitis. Degenerating changes at the intervertebral disc L4 – L5.
 
T2-WI axial view of the lumbar spine. Fluid collection occupying the posterolateral epidural space (red arrow). Inflammatory changes in left psoas and paravertebral muscles (green arrow).
 
T1-WI + Gd lumbar spine axial view. Hypointense collection with rim enhancement occupying the epidural space (red arrow). Inflammatory changes in left psoas and paravertebral muscles. Collection within the left longissimus thoracis muscle (green arrow).
 
T1-cervical sagittal view. Complete resolution of spinal epidural abscesses.
 
T2-cervical sagittal view. Complete resolution of spinal epidural abscesses.
 
T1-dorsal sagittal view. Complete resolution of spinal epidural abscesses.
 
T2-dorsal sagittal view. Complete resolution of spinal epidural abscesses.
 
T1-lumbar sagittal view. Postoperative changes after extensive lumbar laminectomy. Complete resolution of spinal epidural abscesses.
 
T2-lumbar sagittal view. Postoperative changes after extensive lumbar laminectomy. Complete resolution of spinal epidural abscesses.
 
 
 
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