Lumbar pain, right buttock pain with fever, elevated CRP. Evaluate for abscess and osteomyelitis. There is prominent anterior epidural enhancement at L4-S1 that measures up to 8 mm in thickness with several punctate areas that do not enhance. There is associated narrowing of the spinal canal in conjunction with a disc bulge at L5-S1. There is also mild diffuse bone marrow T2 hyperintensity and enhancement at L5-S1, where there is endplate irregularity, but no enhancement of the disc. The vertebral body heights are preserved and the vertebral column alignment is anatomic. There appears to be patchy enhancement in the posterior subcutaneous tissues overlying the right sacrum, although this area is incompletely imaged.
1. Prominent anterior epidural enhancement at L4-S1 that measures up to 8 mm in thickness with several punctate areas that do not enhancement may represent phlegmon associated with spinal canal narrowing, but no evidence of osteomyelitis or discitis. Rather, there is degenerative spondylosis with what likely represents mild bone marrow reactive changes at L5-S1. 2. Apparent patchy enhancement in the posterior subcutaneous tissues overlying the right sacrum may represent cellulitis, although this area is incompletely imaged.