Reason: r/o bilateral iliopsoas abscesses encroaching on spinal cord. R/o osteo, epidural abscess History: bilateral iliopsoas abscesses w/ proximal LE weakness. Five lumbar type vertebral bodies are presumed to be present. There is no abnormal enhancement or edema involving the lumbar spine. No abnormal epidural enhancement or fluid collections to suggest intraspinal abscess. No evidence of discitis-osteomyelitis. There is extensive enhancement involving the left iliopsoas musculature with multiple pockets of fluid, which are incompletely imaged. Pigtail catheter is in place. Fluid collection seen on prior MRI from 5/14/2015 appears to have markedly decreased with residual enhancement involving the right iliopsoas musculature noted. Vertebral body heights are within normal limits. There is mild loss of lumbar lordosis. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Degenerative changes are again seen including disc desiccation at L4-L5 and L5-S1 and moderate loss of disc height at the L5-S1 level with associated endplate marrow signal changes. The spinal canal appears congenitally narrow, worse inferiorly, with superimposed degenerative changes as described below: L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No significant spinal canal or neural foraminal stenosis.L3-L4: There is minimal spinal canal stenosis, predominantly on a congenital basis and prominence of the epidural fat. There is mild disc desiccation with small right foraminal disc protrusion and mild right neural foraminal narrowing. No significant left neural foraminal stenosis.L4-L5: There is moderate spinal canal stenosis, predominantly on a congenital basis, prominence of the epidural fat, as well as a superimposed ligamentum flavum thickening, mild disc bulge with annular fissure. Minimal bilateral foraminal narrowing.L5-S1: There is narrowing of the spinal canal which is predominantly on a congenital basis with superimposed prominence of the epidural fat and mild degenerative changes including disc desiccation, ligamentum flavum thickening, mild disc bulge and endplate osteophytes. There is effacement of the lateral recesses and mild to moderate central canal stenosis. No significant foraminal stenosis.
1. No evidence of extension of infection into the lumbar spinal canal. No evidence of discitis-osteomyelitis or epidural abscess.2. Residual fluid collection/abscess involving the left iliopsoas musculature is better imaged on recent CT study. There is improvement/resolution of the previously partially imaged right iliopsoas abscess on prior MRI from 5/14/2015. There may be impingement of the peripheral course of the lumbosacral nerve roots/plexus to explain the given history of lower extremity weakness but not well evaluated on this lumbar spine study.3. Degenerative changes are again seen including moderate spinal canal stenosis at L4-L5 and L5-S1 as detailed above.