Male, 65 years old, with esophageal ulcer and possible exposed bone. Evaluate for osteomyelitis of the vertebral bodies. An ET tube is in place with fluid surrounding the tube within the pharynx. At the level of the C4 and C5 vertebral bodies, this fluid appears to extend posteriorly through a potential defect or ulceration in the hypopharyngeal wall to the level of the anterior vertebral bodies. No definite rim-enhancing or diffusion restricting collection is seen to suggest the presence of an abscess. The mucosa is edematous and enhancing compatible with inflammation. The marrow signal of the adjacent C4 and C5 vertebral bodies demonstrates T1 hypointensity but with little definite T2 signal abnormality and no clear correlating diffusion restriction or pathologic enhancement. No pathologic adenopathy is seen. No compromise of the spinal canal is detected. A scarlike opacity in the right lung apex has been better assessed on dedicated chest imaging.
Findings are seen compatible with ulceration of the posterior hypopharyngeal wall at the C4 and C5 levels, potentially extending to the level of the vertebral bodies. The surrounding mucosa is inflamed but there is no evidence to suggest an adjacent soft tissue abscess. The C4 and C5 vertebral bodies show relatively mild marrow signal abnormality which could indicate early osteomyelitis or perhaps just reactive edema.