Clinical question: Wound infection, evaluate for treatment response. Signs and symptoms:Wound infection, evaluate for treatment response. Pre-and post-enhanced lumbar MRI:Examination redemonstrates postoperative changes of lower lumber spine posteriorly and including placement of metallic hardware at L3 -- L4 level.New since prior exam is a large loculated focus of T2 hyperintensity likely representing fluid surrounding the cluster of metallic hardware which measures approximately at 30 x 41-mm in transaxial dimensions and we craniocephalad extension of approximately 47 millimeter.Additionally there is evidence of a knee large focus of fluid collection in the soft tissues of lower back involving the cutaneous and subcutaneous fat. This fluid accumulation measures at least at the 40 x 41 mm in transaxial dimensions and 74.4-mm in craniocephalad axis. There is also evidence of significant soft tissue thickening/increased volume with T2/T2 stir hyperintensity of the soft tissues in the subcutaneous fat of the lower back which includes the musculature and partial planes.On post enhanced images there is diffuse enhancement of posterior soft tissues of the lower back and the surgical site and in enhancement of the new foci of fluid accumulation. The extent of this finding has increased since prior exam and suspected of progression of inflammatory/infectious process.Previously noted mild posterior dural thickening and enhancement and with resultant subtle mass effect on the dorsal aspect of thecal sac demonstrate however no significant change since prior study. There is no detectable new foci of signal abnormality of vertebral bodies, disk spaces or the epidural space since prior study. Mild central spinal stenosis at L4 -- 5 demonstrate no evidence of change since prior study.
1.New loculated fluid collection surrounding the cluster of metallic hardware posteriorly at L3 -- L4 level as detailed/measured above.2.New loculated irregular fluid collection in the soft tissues of posterior lower back and including the cutaneous tissues without convincing detectable communication with the above mentioned fluid collection surrounding metallic hardware.3.Interval increased T2 hyperintensity and volume of all soft tissues of posterior lower back at the surgical site and with diffuse enhancement which surrounds the above mentioned fluid collections. Constellation of above findings are highly suggestive of progression of inflammatory and possibly infectious process.4.Post operative dural thickening and mass effect along the dorsal aspect of thecal sac at the L4 and L5 levels demonstrate no evidence of interval change in thickness, extent and pattern of enhancement. This findings similar to prior exam demonstrate subtle mass effect on the thecal sac.5.Mild central spinal stenosis at L4 -- L5 without interval change since prior exam.6.No detectable intracanalicular inflammatory/infectious/ abscess formation.