Case 36 - Tuberculous Spondylitis with Psoas Abscess

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

EXAM: MRI L-SPINE W/WO CONTRAST

INDICATION: 34-year-old female with a pathologic fracture of L4 and bilateral psoas fluid collections being treated for active TB.

TECHNIQUE: Sagittal T1, T2, STIR, and axial T1 and T2-weighted images of the lumbar spine were acquired with and without contrast.

COMPARISON: CT lumbar spine with contrast on 9/18/2019

FINDINGS:

Lumbosacral transitional anatomy with 4 lumbar type vertebral bodies and sacralization of L5. Conus medullaris terminates at the L1 level, normal.

Pathologic fracture of the L4 vertebral body extending into the right pedicle. There is T2 STIR hyperintensity extending into the right greater than left L4. there are 2 ovoid centrally T2 hyperintense with thick enhancing walls compressing the superior

aspect the L4 vertebral body, measuring approximately 1.9 x 7.4 x 1 cm and 1.8 x 1.3 x 0.7 cm. Peripherally enhancing mass at the posterior inferior L3 vertebral body measuring approximately 1.1 x 1.5 x 0.7 cm.

There is thick enhancement posteriorly between the L3 and L4 vertebral bodies in the anterior epidural space. Mass effect from the thick enhancement at the L3-4 level resulting in severe spinal canal stenosis and severe right neural foraminal stenosis secondary to enhancing mass.

There is also thickening and enhancement at the anterior longitudinal ligament extending from L3 to the superior sacralized L5 level. No abnormal enhancement or STIR signal within the sacralized L5 vertebral body. Mild T2 STIR hyperintensity at the anterior longitudinal ligament at the T12 level without enhancement.

Multiple peripherally enhancing and centrally mildly T2 hypointense lesions within the right greater than left psoas muscles. This lesion abuts the right common iliac vein.

There is mild T2 hyperintensity in the right paraspinal muscles, likely representing edema.

Modic type II change at the inferior endplate of L1.

IMPRESSION:

1. Pathologic fracture of the L4 vertebral body extending into the right pedicle, seen on previous CT lumbar spine on 9/18/2018. There are multiple masses at the L3 and L4 vertebral bodies, measuring up to 1.9 cm with central T2 hypointensity and peripheral thick enhancement, concerning for abscesses. Findings consistent with discitis/osteomyelitis extending from the L3 level to the L4-5 disc space. Note there is lumbosacral transitional anatomy with 4 nonrib-bearing lumbar-type vertebral bodies.

2. Thick enhancement extending into the anterior epidural space resulting in severe spinal canal and right neural foraminal stenosis at the L3-4 level. Thickening and enhancement of the anterior longitudinal ligament extending from the mid L3 to superior sacralized L5 level.

3. Peripherally enhancing masses in the right greater than left psoas muscles, concerning for abscesses. Consider tuberculosis as a potential pathogen.