Lower extremity weakness and low back pain. Epidural and paraspinal abscesses. On antibiotics. Assess for change. The anterior sacral epidural space now shows symmetric contrast enhancement with resolution of the fluid pockets/abscesses. It has not changed significantly in overall thickness. The contrast enhancement with small fluid pocket anterior to the sacrum remain unchanged. The abscesses in the posterior paraspinal muscles, most pronounced at S2 level, are significantly smaller. On the right, the largest measures 0.8 cm x 0.5 cm, compared to 2.1 cm x 1.6 cm previously. The largest on the left measures 0.8 cm x 0.4 cm, compared to 1.8 cm x 1.3 cm previously. There continues to be abnormal contrast enhancement bilaterally in the sacral foramina and also involving the inferior aspect of the right L5-S1 neural foramen. There continues to be no osseous erosion or abnormal disc or marrow enhancement. The vertebral bodies are preserved in height. Mild multilevel degenerative disease has not changed. There is no abnormal contrast enhancement along the cauda equina. A 1.5 cm cyst in the upper pole of the left kidney is unchanged.
1.Epidural infectious process is now more phlegmon-like, with resolution of the previously seen epidural fluid collections. 2.The posterior paraspinal abscesses are significantly smaller. 3.Presacral fluid collections and abnormal contrast enhancement remain. These are better assessed on CT scan of the pelvis.