Lumbar pain, right buttock pain with fever, elevated CRP. Evaluate for abscess and osteomyelitis. There is prominent anterior epidural enhancement at L4-S1 that measures up to 8 mm in thickness with several punctate areas that do not enhance. There is associated narrowing of the spinal canal in conjunction with a disc bulge at L5-S1. There is also mild diffuse bone marrow T2 hyperintensity and enhancement at L5-S1, where there is endplate irregularity, but no enhancement within the disc space. The vertebral body heights are preserved and the vertebral column alignment is anatomic. There appears to be patchy enhancement in the posterior subcutaneous tissues overlying the right sacrum, although this area is incompletely imaged.
1. Prominent anterior epidural enhancement at L4-S1 that measures up to 8 mm in thickness with several punctate areas that do not enhancement may represent phlegmon associated with spinal canal narrowing in conjunction with a disc bulge at L5-S1. Enhancement within the adjacent vertebral bodies may represent reactive changes from degenerative spondylosis, although superimposed early osteomyelitis cannot be excluded, particularly in the posterior portion of the L5 vertebral body.2. Apparent patchy enhancement in the posterior subcutaneous tissues overlying the right sacrum may represent cellulitis, although this area is incompletely imaged.