Concern for CSF leak, infection. Recent resection of L1-L2 tumor. Five lumbar type vertebral bodies are presumed to be present. There is normal lumbar lordosis. Postsurgical changes of a left L1 hemi-laminectomy for tumor resection and posterior left L1-L2 fixation with pedicle screws and unilateral paraspinous rod are redemonstrated. Additionally, there appears to have been partial resection of the inferior aspect of the L1 vertebral body.There is a fluid collection extending along either side of the spinous processes from T12 to L3. The collection on the left measures 11 mm in thickness and 8 cm in its craniocaudal dimension and appears to communicate with the skin surface. While the fluid collection on the left has a relatively simple fluid appearance, the fluid collection on the right which measures approximately 9 cm in the craniocaudal dimension and 2 cm in thickness demonstrates significant heterogeneous signal, which likely reflects internal debris or blood products. There is peripheral enhancement associated with both collections. Increased enhancement of the paraspinal musculature, left greater than right, may reflect myositis. There is no evidence of epidural abscess or discitis/osteomyelitis. No residual tumor is definitively appreciated The vertebral body and disk heights are well-maintained. Disc desiccation and disc bulge with mild to moderate narrowing of the neuroforamina affects L5-S1. There is no significant spinal canal stenosis. No focal marrow signal abnormality is appreciated. The conus medullaris and cauda equina nerve roots are unremarkable.
1. Posterior paraspinous fluid collection from T11 to the L3 levels with peripheral enhancement and inflammatory changes in the adjacent musculature. Given recent surgery, differentials include seroma and pseudomeningocele with superimposed infection/abscess not excluded. The fluid collection component on the right demonstrates heterogeneous signal likely reflecting internal debris/blood products while the fluid collection on the left demonstrates signal features more compatible with simple fluid. The collection on the left appears to extend to the skin surface along the surgical tract. Fluid sampling is suggested for further evaluation.2. There is no epidural abscess or spinal canal stenosis at any level.