Male, 52 years old, status post transhiatal esophagectomy 08/17/15 after neoadjuvant chemoradiotherapy, now presenting with left scapular pain radiating to the neck and back. Abnormal T1 hypointensity and STIR hyperintensity is evident within the T1 and T2 vertebral bodies. The intervening disc space also shows abnormal STIR hyperintensity. The vertebral bodies and intervening disc are enhancing with extension of ill-defined enhancement to the anterior and left anterior paraspinal soft tissues where it becomes contiguous with a presumed gastric pull-up. No obvious fluid collection is detected. The left T1-2 and T2-3 neural foramina are encompassed by this process. In addition, there is mild thickening of the left ventral epidural tissues at T1 and T2. However, no high-grade spinal canal stenosis is suspected. No abnormal signal intensity or pathologic enhancement is detected within the spinal cord parenchyma.The remaining vertebral bodies demonstrate normal signal characteristics and are free of pathologic enhancement. Spinal alignment is anatomic. Vertebral body heights are preserved. Scattered mild degenerative findings are seen but there are no areas of associated spinal canal or foraminal stenosis.
Findings are seen compatible with discitis osteomyelitis at T1-2. Inflammation extends to the anterior and left anterior paraspinal soft tissues where it becomes contiguous with the adjacent gastric pull-up. No frank abscess is identified.There is mild inflammatory thickening of the epidural soft tissues as well but no significant spinal canal compromise is detected. The left neural foramina at T1-2 and T2-3 appear to be encompassed by inflammation as well.