Presentation
IVDU with difficulty mobilizing and lower limb weakness.
Patient Data
Note is made of prior fusion of L2 and L3 vertebral bodies.
There is near complete collapse of L3 vertebral body, with destruction of the L3/L4 intervertebral disc and an irregular peripherally enhancing collection at the L3/4 intervertebral disc space. Marked irregularity of the L3 inferior endplate and L4 superior endplate is also demonstrated. There is partial collapse and diffuse abnormal signal/enhancement of the L2 and L4 vertebral bodies.
A focal kyphosis is demonstrated from L2-4 and there is abnormal enhancement extending within the anterior epidural space at L3/4, however, there is no discrete epidural collection. At L3/4, there is distortion of the thecal sac with moderate spinal canal stenosis and bilateral neural exit foraminal stenoses.
Extensive abnormal signal/enhancement is demonstrated within the prevertebral tissues and involves the right psoas muscle. The enhancement extends along the exiting right L3 and to a lesser extent L2 and L4 nerve roots. Diffuse interspinous enhancement is also demonstrated, with extension into both facet joints at L3/4.
Conclusion: Features are those of discitis/osteomyelitis.
Case Discussion
The patient underwent a biopsy that aspirated frank pus.
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