Wk 3, Case 30 - Review

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EXAM: MRI L-SPINE W/WO CONTRAST

INDICATION: Back pain and fever with history of IV drug use.

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

COMPARISON: None

FINDINGS:
The conus medullaris terminates at L2.

The nerve roots of the cauda equina are evenly distributed within the thecal sac.

The L4 and L5 vertebrae demonstrate increased signal on STIR and decreased signal on T1 with irregularity and erosion of the inferior endplate of the L4 vertebra and the superior endplate of L5.

Post gadolinium sequences demonstrate marked enhancement of the intervertebral disc at L4-L5. Axial postcontrast images demonstrate enhancing soft tissue anterior to the thecal sac at L4-L5, compatible with epidural infection. Enhancement also noted within the medial aspect of the bilateral psoas muscles at the L4-L5 level. No discrete paraspinal collection/abscess.

Degenerative disc disease at L5-S1 with broad-based disc bulge resulting in moderate bilateral foraminal narrowing and mild spinal stenosis.

Visualized abdominal viscera is unremarkable.

Recommend correlation with patient's sedimentation rate, CRP, and white blood cell count.

IMPRESSION:
Discitis-osteomyelitis at the L4-L5 level with associated bilateral paraspinal/psoas phlegmon and epidural infection.

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

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Wk 3, Case 30 - Review