Male, 52 years old, with septic shock secondary to MRSA bacteremia, assess for infection. Brain:Brain parenchymal morphology is unremarkable. No evidence of edema, mass effect or significant parenchymal signal alteration is demonstrated. Diffusion-weighted images are within normal limits.No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is normal in size and morphology. Loss of the left sigmoid sinus and internal jugular flow void is seen compatible with thrombosis.The mastoid air cells are opacified and there is mucosal thickening in the sphenoid sinuses. Pooling fluid is seen in the nasal cavity and pharynx likely related to intubation.Neck:The left IJ vein is thrombosed down to the level of C6. Extensive edema of the paraspinal musculature is seen most severely centered at the C1 and C2 levels. This edema wraps around the left aspect of the vertebral bodies to involve the left longus coli.At the C2 level, and to a lesser degree at C1 and C3, the ventral epidural space is thickened with very T2 hyperintense, diffusion restricting material. This results in a moderate narrowing of the spinal canal at C2 and minimal deformation of the spinal cord contour. No evidence of spinal cord edema is seen. The adjacent vertebral bodies show no evidence of significant marrow edema. However, the left lateral C1-2 articulation is edematous and may contain some fluid.Fluid and edema involving pharynx are again seen. Scattered prominent lymph nodes are evident more so in the left neck than the right. The visualized major salivary glands are unremarkable. The thyroid is not well assessed due to artifact in the region. Opacification is noted in the left lung apex.
The left IJ vein is thrombosed down to the C6 level. In addition, significant edema is seen within the paraspinal muscles of the upper neck, centered at C2, also wrapping anteriorly to involve the left longus coli muscle. In association with this, there is thickened, T2 hyperintense and diffusion restricted material within the ventral epidural space at C2, and to a lesser degree at C1 and C3. This results in a moderate narrowing of the spinal canal and slight deformation of the cord but no evidence of cord edema. Taken as a whole, these findings are highly concerning for paraspinal cellulitis with associated epidural abscess or phlegmon, perhaps secondary to infected thrombophlebitis of the left internal jugular vein. Findings were discussed with Dr. Ernst at 9:30 AM on 1/12/2016.Intracranially, left IJ thrombosis continues into the left sigmoid sinus. However, no significant parenchymal signal abnormality or intracranial fluid collections are observed. The mastoid air cells are opacified which, given the clinical context, could be reactive to intubation or reflective of an infectious process.