0:01

This was a middle aged patient who presented

0:04

with fever and dysphasia.

0:08

The patient was known to be an intravenous drug abuser.

0:12

On the sagittal T1-weighted scan,

0:14

as we come down into the thoracic region, we come to the

0:17

T2-T3 level where there is low signal intensity in the

0:22

inferior endplate of T2 and low signal intensity

0:25

in the inferior endplate of T3 on either side of the disc.

0:30

On the T2-weighted scans, we see that there is high signal

0:34

intensity in the endplate as well as in the disc, which on the

0:39

post-gadolinium enhanced scan, we can see it shows endplate

0:43

as well as disc enhancement.

0:46

Not only that,

0:47

but you are seeing diffuse enhancement in the epidural

0:50

space likely reactive to this infectious process.

0:54

Curiously,

0:55

you also see that there appears to be a collection anterior

1:00

to the spinal canal which is compressing the esophagus.

1:06

And this is intermediate in signal intensity on T2

1:09

and dark in signal intensity on T1-weighted scan.

1:12

Let's look at the axial post-gadolinium enhanced

1:15

scan to better characterize this.

1:18

And here you can see that there is diffuse epidural enhancement

1:23

around the thecal sac from spread of the inflammation.

1:27

And coming more inferiorly,

1:29

we see that there is fluid collection on either side of the

1:34

spinal canal with displacement of the esophagus anteriorly,

1:40

and to the right side, by this big collection.

1:44

So this is a patient who has discitis and osteomyelitis

1:49

associated with a large anterior epidural abscess,

1:54

leading to the patient's dysphasia.