 Images are slightly limited by patient motion. There is extensive prevertebral soft tissue swelling, measuring up to 2.8 cm at the lower C2 level. Indwelling instrumentation is identified from previous anterior cervical fusion of C3 and C4, with associated susceptibility artifact limiting evaluation of surrounding structures. Lack of fat saturated axial postcontrast images limits evaluation for areas of abnormal enhancement, although fat saturation would also likely be degraded secondary to the instrumentation.Within these limitations, there is redemonstration of a bilobed appearing peripherally enhancing fluid collection within the prevertebral space extending from the lower C2 to the C4 level, measuring 4.0 cm CC. The collection measures approximately 1.3 x 1.1 cm in greatest axial dimensions on 1301/34 on postcontrast images, with the area of abnormality measuring up to 1.4 x 1.8 cm on axial T2-weighted images. This essentially involves the oropharynx, with again significant narrowing of the airway focally at this level as there is also prominence of the lingual tonsils. The previously described sinus tract extending to the left anterolateral skin surface near the level of the thyroid cartilage is better delineated on CT, but is visualized on the axial T1 precontrast images.Evaluation of the bone marrow signal and enhancement on MRI is extremely limited secondary to the artifactual hyperintensity present from the indwelling instrumentation. Bone integrity and possibility of infection is likely better assessed on CT, where subtle periosteal reaction or destruction could be appreciated. STIR hyperintensity is present within the C2-C3 disc space posteriorly which could be artifactual and ventrally within the C4-C5 disc although not contiguous with the prevertebral abnormal signal.There is redemonstration of extensive inflammatory changes within the left greater than right prevertebral soft tissues at these levels, with extension of abnormal signal and enhancement into the left longus coli muscle, with involvement that is located more medially along its cranial aspect although more diffuse involvement is noted at the greatest levels or prevertebral soft tissue swelling. At the C3-C4 level, there is a small partially exophytic portion of the abscess extending posteriorly on 701/29 towards the anterior cortical margin upper C4 vertebral body.The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. There is no pathological enhancement. The spinal cord appears somewhat diminutive in size diffusely. In addition, focal abnormal signal is seen within the cord the right side at C3-C4, likely relating to myelomalacia.At C2-C3, there is a prominent central disc protrusion and bilateral uncovertebral hypertrophy resulting in moderate central spinal canal stenosis. There is mild bilateral foraminal narrowing.At C3-C4, there is likely moderate central spinal canal stenosis with no evidence of disc pathology at this level previous surgery. There is bilateral uncovertebral hypertrophy with moderate lateral foraminal narrowing.At C4-C5, there is bilateral uncovertebral hypertrophy with mild bilateral foraminal narrowing.At C5-C6, there is a shallow central disc protrusion with left paramedian annular fissure. There is mild bilateral foraminal narrowing.At C6-C7, there is a trace disc bulge without stenosis.At C7-T1 and T1-T2, there is no significant disk pathology or stenosis.At T2-T3, there are biforaminal small disc protrusions with bilateral facet arthropathy resulting in moderate bilateral foraminal narrowing.
1. Motion limited exam. Redemonstration of known left posterior oropharyngeal wall abscess with prevertebral extension from the lower C2 to upper C4 level. Osseous and disc involvement is somewhat difficult to assess due to the extensive artifact from the indwelling spinal instrumentation at these levels, although osseous integrity appears to be preserved on the CT neck exam. Increased STIR signal within the relevant disc spaces may simply be artifactual. Normally, diffusion weighted imaging could be attempted to evaluate for discitis/osteomyelitis, although likely these would not be helpful in this patient secondary to the presence of instrumentation and related artifact. Close follow-up is recommended, as a component of the abscess does extend superiorly towards the anterior margin of the upper C4 vertebral body, and there is extensive left longus coli involvement likely representing myositis.2. Redemonstration of known sinus tract extending to the left anterolateral neck skin surface, not as well delineated as on CT.3. Evidence of myelomalacia of the cervical cord focally at C3-C4 likely relating to previous disc pathology, with overall mild atrophy of the cervical cord. Multilevel spondylotic changes as detailed above.