Female, 74 years old, with extradural subdural abscess. Evaluate for progression. History of RA, SLE and A. fib. Extensive edema and ill-defined enhancement is seen involving the left paraspinal soft tissues at C4 and C5. The left C4-5 facet complex is involved with evidence of marrow edema and abnormal marrow enhancement. The C5 component of the facet joint is particularly eroded, compatible with findings noted on prior CT. Thickened enhancing tissue is also seen intraspinally at the C4-5 level involving the left posterior epidural space. At most, there may be trace epidural fluid in this location, but no discrete or drainable collections are seen. This epidural process does contribute to moderate narrowing of the thecal sac. On comparison with the prior exam, the epidural thickening has decreased from 5 mm to 3 mm, and previously seen small locules of possible epidural fluid have resolved.The vertebral bodies and facets otherwise demonstrate normal signal intensity and morphology. There is a grade 2 anterolisthesis of C5 relative to C6. A scoliotic curvature is also seen. Vertebral body heights are grossly preserved.The visualized spinal cord demonstrates normal signal intensity. No pathologic cord or leptomeningeal enhancement is seen. As noted above, there is spinal canal narrowing at the C4-5 level which does contribute to slight deformation of cord morphology, but no cord edema is seen.Incidentally noted is an enlarged left thyroid lobe with one or more nodular lesions.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Marked left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C4-5: Marked left facet edema, enhancement and destruction. Mild posterior disc-osteophyte complex formation. Moderate spinal canal narrowing primarily due to epidural thickening. Moderate left foraminal narrowing. C5-6: Advanced left facet arthropathy. Spondylolisthesis with disc bulging and disc uncovering. Mild to moderate spinal canal narrowing without significant cord deformation. Moderate left foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal compromise. C7-T1: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal compromise.
Edema, abnormal enhancement and osseous destruction is seen centered on the left C4-5 facet complex. The surrounding paraspinal soft tissues are also edematous and enhancing.The left posterior epidural tissues at C4-5 are thickened and solidly enhancing. Small possible locules of epidural fluid seen on the prior outside examination appear to have resolved, and the degree of epidural thickening has improved as well.The above findings are compatible with infection, perhaps centered on the left C4-5 facet complex. Although the epidural tissues at this level are likely involved, no definite residual epidural collection is seen. The spinal canal is moderately narrowed at this level.