 Examination is degraded due to patient motion. Lack of contrast also limits evaluation for infection. For the purposes of numbering, the most inferior well-defined disc space is labeled L5-S1. There is abnormal T2/STIR hyperintensity involving the L2-L3 disc space with signal abnormality also involving the inferior and superior aspects of the L2 and L3 vertebral bodies, respectively. There is extensive edema involving the lumbar paraspinous musculature. There is also edema involving the left psoas muscle and probably to a mild degree involving the right psoas muscle. There is a small tubular fluid collection within the left psoas muscle which measures 13 x 18 mm (axial T2 series 1401 image 24/50) in the maximal axial dimensions at the L3 level with smaller components extending from the L2-L3 to the L4-L5 levels, highly suspicious for abscess. No significant destructive changes are appreciated at the endplates.No clear evidence of discitis-osteomyelitis in the thoracic spine. Subtle foci of STIR hyperintensity are seen at multiple levels in the mid thoracic spine involving the disc space and along the left lateral aspects of the endplates which are nonspecific and may be related to degenerative change versus represent early infection. Note, precise levels in the mid thoracic spine is difficult to determine due to motion degradation. Thoracic and lumbar vertebral bodies and alignment are maintained. There is no significant spinal canal stenosis at any level. No cord signal abnormality is appreciated. No evidence of epidural collections within the limits of noncontrast imaging.Degenerative changes in the lumbar spine are suboptimally evaluated due to motion degradation, but there are multilevel disc bulges as well as mild multilevel facet arthropathy. There is associated moderate left L2-L3 neural foraminal stenosis, moderate right and mild left L3-L4 neural foraminal stenosis, and moderate right and mild left L4-L5 neural foraminal stenosis. No significant spinal canal stenosis.There is moderate left pleural effusion and a smaller one on the right.
1. Examination is motion degraded and limited without contrast. There are findings however highly suspicious for discitis-osteomyelitis at the L2-L3 level with associated abscess involving the left psoas muscle. Measurements of the abscess, which has a tubular morphology, as above.2. Subtle additional areas of signal abnormality are suspected in the mid thoracic spine involving the disc and endplates which are nonspecific but raise possibility of early infection. Would recommend including thoracic spine when follow up spine imaging is considered.3. No significant spinal canal stenosis or evidence of epidural abscess within the limits of noncontrast imaging.