Clinical question: Epidural abscess, diskitis. Signs and symptoms: Paraspinal pain, elevated WBC. Pre-and post-enhanced cervical spine MRI:Examination demonstrate normal anatomical alignment vertebral column however with mild reversal of cervical lordosis.The signal intensity of spine is unremarkable other than changes secondary to degenerative disease.There is no evidence of diskitis, osteomyelitis or epidural abscess as these questioned clinically.The signal intensity of the cord remains reading normal.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate a central and rightward broad based disk protrusion with resultant flattening and posterior displacement of the cord and moderate central spinal stenosis. Patent bilateral neural foramina and no detectable cord signal abnormality.C4 -- C5 demonstrate moderate disk disease, loss of disk height and a broad-based disk osteophyte complex. There is flattening and posterior displacement of the cord and moderate central spinal stenosis. There is mild bilateral neural foraminal compromise.C5 -- C6 demonstrate mild disk disease, a disk/osteophyte complex on the left results in flattening and posterior displacement of the cord and mild central spinal stenosis. Mild right neural foraminal compromise is also present.C6 -- C7 is unremarkable.C7 -- T1 is unremarkable.Pre-and post-enhanced thoracic MRI:There is normal anatomical alignment the vertebral column however with mild exaggerated kyphosis of thoracic spine. There is unremarkable signal intensity of thoracic spine.There is no evidence of diskitis, osteomyelitis or epidural abscess as clinically is questioned.There is normal signal intensity of the thoracic cord and without evidence of abnormal enhancement.There is no evidence of central spinal stenosis or significant neuroforaminal compromise at any level. Mild degenerative disk disease and hypertrophic changes of posterior elements are noted in the thoracic spine.Pre-and post-enhanced lumbar spine:Examination demonstrate no evidence of diskitis, osteomyelitis or epidural abscess as is questioned clinically.There is normal anatomical alignment the vertebral column. There is no evidence of spinal canal or neural foraminal compromise at any level. Incidentally note is made of an enlarged uterus with multiple well-demarcated foci of low-attenuation suspect that a fibroma. Recommend follow-up with the dictated imaging for better assessment and to exclude other pathology.
1.Pre-and post-enhanced MRI of the cervical spine demonstrate no evidence of diskitis/osteomyelitis or epidural abscess. There is evidence of extensive degenerative disk disease and with multilevel osteophytes and disk protrusion resulting in central spinal stenosis at C3 -- C4, C4 -- C5 and C5 -- C6 levels and multilevel neural foraminal compromise as detailed per level.2.Pre-and post-enhanced MRI of thoracic spine demonstrate no evidence of osteomyelitis, diskitis or epidural abscess. There is no redness on the spinal canal or neural foraminal compromise. Mild degenerative changes of thoracic spine and slight exaggeration of thoracic kyphosis is noted.3.Pre-and post-enhanced lumbar MRI demonstrate no evidence of diskitis, osteomyelitis or an epidural abscess. No spinal stenosis or neuroforaminal compromise at any level. 4.Incidental note is made of an enlarged uterus and highly suspected multiple fibromas. Recommend follow-up with dedicated imaging to exclude other pathologies.