Presentation
Severe low back pain, fever, weight loss and elevated CRP.
Patient Data
Age: 60 years
Gender: Female
From the case:
Tuberculous spondylodiscitis
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The MRI sequences demonstrate:
- lumbar scoliosis of left-sided convexity centered on L2-L3
- narrowing of L2-L3 disc space with intradiscal abscess and irregularity of the vertebral end-plates
- abnormal signal of L2 and L3 vertebral bodies with heterogeneous enhancement on postcontrast sequences
- thickening with enhancement of the pre/paravertebral and anterior epidural spaces with multiple abscesses formation, extending from the anterosuperior angle of L3 to the anteroinferior angle of L5 anteriorly and from the posterosuperior angle of L2 to the posteroinferior angle of L3 posteriorly, the largest is of anterior prevertebral location measuring (3.5 x 3 x 2 cm)
- abscesses formation of the psoas muscles, the largest measures (6 x 5 x 3.6 cm)
- bone marrow edema with enhancement of L4 and L5 as well
Case Discussion
The clinical presentation and the MRI features are most consistent with a tuberculous spondylodiscitis with multiple abscesses formation of the pre/paravertebral and epidural spaces as well as the psoas muscles.
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