History of Crohn's disease with small and large bowel fistulae. CT scan from February 6, 2016 showed the gas in the fistulae tracking into the spinal canal. The abdomen/pelvis CT scan from February 6, 2016 provides better assessment of the partially included bowel and associated fistulae. Also, the presacral inflammatory soft tissue thickening is better assessed on CT scan but contains foci of poor contrast enhancement on MRI suggesting the presence of abscesses. 8 mm well-circumscribed T2-hyperintense, noncontrast enhancing lesion in the right kidney may represent a small cyst but is not completely characterized.There is a peripherally contrast enhancing anterior epidural fluid collection that also contains gas and extends from the upper L5 level to the upper most S2 level. The associated epidural inflammatory changes extend inferiorly throughout the sacral canal. The fluid collection itself measures craniocaudally 5.0 cm. In transverse at L5 level, the fluid collection measures 12 mm x 9 mm while at S1 level with measures 9 mm x 4 mm. It causes severe spinal canal stenosis at L5-S1 caudad, which is more pronounced on the right side, including the right subarticular recess at L5-S1. This is compatible with an epidural abscess. This collection also involves the L5-S1 neural foramen, more pronounced on the right, where gas tracks within the neural foramen. The epidural gas extension along the L5-S1 and the sacral foramina was more extensive on the CT scan.In addition, there are similar peripherally contrast enhancing fluid collections that contain gas within the posterior paraspinal muscles extending from mid L5 to upper S3 level, measuring more than 7 cm craniocaudally. Axially at mid S1 level, the right-sided one measures 2.5 cm x 2.1 cm while the left-sided one measures 2.1 cm x 1.6 cm. These are associated with edema like signal in the adjacent muscles and fat.The sagittal lumbar spinal alignment is notable for straightening which may reflect patient position or muscle spasm. The vertebral bodies are preserved in height. The marrow signal is diffusely T1/T2-hypointense which probably reflects red marrow reconversion related to chronic anemia or chronic illness. Sacral marrow is heterogeneous and STIR hyperintense which might be reactive to the adjacent presacral and intraspinal epidural inflammatory change. There is no lytic osseous destruction.Besides the above described lower lumbar and sacral spinal canal narrowing by the epidural abscess, there is no significant upper/mid lumbar canal stenosis. The conus medullaris tip is at the lower L1 level. The conus medullaris is unremarkable.
1.There is an epidural abscess in the lower lumbar and sacral spinal canal with severe spinal canal stenosis. The associated gas also extends along the L5-S1 and the sacral foramina. 2.There are also abscesses within the posterior paraspinal muscles. Gas within these abscesses suggest communication either with skin or bowel.3.The presacral inflammatory tissue is not completely assessed nor the other abdominal or pelvic findings.4.Heterogeneous/edematous sacral marrow signal might be reactive to the adjacent inflammatory change but may also represent early osteomyelitis. No frank osseous destruction is evident.