Presentation
Female presented with chronic lower backache, low grade fever and tenderness over the sacrum.
Patient Data
There is abnormal enhancing lesion which is hypointense on T1 and hyperintense on T2 and STIR sequences involving the L4-L5 intervertebral disc and the L4 and L5 vertebral bodies,resulting in discitis, end plate erosion, erosion of anterior margins of L4 and L5 vertebral bodies. There is poor delineation of disc-endplate interface. Abnormal enhancing collection which is hypointense on T1 and hyperintense on T2 and STIR noted around the L4 and L5 vertebrae extending deep to anterior longitudinal ligament (anteriorly) to the epidural space (posteriorly) compressing the thecal sac and leterally upto the medial margins of bilateral psoas muscle.
The imaging findings are suggestive of spondylodiscitis with paravertebral abscess.
Case Discussion
Discitis or spondylodiscitis is most commonly caused by Staphylococcus aureus, however it can also be caused by tuberculosis in late stage of disease. It is usually seen as hypointense on T1 and hyper or intermediate intense on T2 and STIR and shows brilliant post contrast enhancement as seen in the case.
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