Clinical question: Evaluate for abscess. Signs and symptoms: Fever status post thoracic procedure. Pre-and post-enhanced thoracic MRI:Examination demonstrates the new small likely postoperative epidural collection measuring approximately 13 times 15 mm in transaxial dimensions. It applied very subtle mass effect on the dorsal aspect of thecal sac and with resultant minimal forward deviation of the cord. Post-enhanced images demonstrate expected enhancement of the soft tissues posterior to the surgical multi-level laminectomy and including tissues surrounding the epidural collection. This appearance is within expected postoperative findings. Possibility of overlapping infection cannot be entirely excluded. There is no detectable abnormal enhancement of the cord or the leptomeninges.Compared to prior exam there is evidence of decreased cord caliber however without change in the extent of T2 hyperintensity of the cord (edema) which extends from T3 inferiorly to approximate the the conus. Decreased cord caliber results in better visualization of subarachnoid space throughout the thoracic spine.Also new since prior exam is a thin linear T2 hypointensity traversing the cord from approximately T8 -- T9 disk level inferiorly and appears to exit the thecal sac posteriorly at T9 -- T10 disk level. Finding is believed to represent a surgically placed device/drain. Correlate with surgical notes. The appropriateness of its placement should be decided by the referring clinical physician.
1.Small epidural collection posteriorly at T9 and T10 with surrounding soft tissue enhancement is within expected postop change. Possibility of overlapping infectious however cannot be entirely excluded.2.This collection applies subtle mass effect on the thecal sac and cord.3.There is a surgical device likely a drain traverses the cord at these levels and exits the spinal canal posteriorly. The appropriateness of its placement should be decided by the referring clinical physician.4.There is interval decreased caliber of thoracic cord with resultant better visualization of the subarachnoid space since prior exam from January 2015. This is likely as result of placement of drain. 5.There is no detectable abnormal enhancement of the cord or the leptomeninges.6.There is no change in the extent of cord T2 hyperintensity which extend from T3 to approximately the level of conus similar to prior exam.