Vertebral osteomyelitis at the T12, L1, L2 and L3 levels with the main focus at the L1/L2 level. Status post three months of antibiotic treatment, now with continued pain. There has been interval significant loss of height of the L2 vertebral body with retropulsion of osseous fragments and disc material into the spinal canal which now causes severe spinal canal stenosis compared to the prior MRI from 6/17/2015. However, these findings appear similar to the CT abdomen and pelvis exam from 8/29/2015 taking into account differences in modality. The spinal canal diameter at the L1/2 level measures at most 5 mm in AP dimension. Redemonstrated are additional foci compatible with osteomyelitis involving the T12 and L3 vertebral bodies. There is more extensive enhancement within the L1-2 disc and adjacent endplates and the L1 vertebral body indicating more extensive discitis and osteomyelitis. Ill-defined enhancement of soft tissues along the medial aspect of bilateral psoas muscles and prevertebral space especially area again demonstrated, especially at the level of L2 vertebral body. The previously described microabscesses are not as readily apparent on today's exam. There is no visible evidence of an epidural abscess. Again seen are cystic lesions in the kidneys bilaterally, most likely representing benign renal cysts. On the right side, external to the back muscle group fascia, there is a very subtle well circumscribed fat containing lesion within the subcutaneous tissue likely representing a lipoma. This has been characterized on the recent CT of the abdomen and pelvis.
1.Redemonstration of multilevel vertebral osteomyelitis with interval development of significant discitis at the L1/2 level, significant loss of height of the L2 vertebral body and progression of enhancement of the L1 vertebral body. 2.At the L1/2 level there is retropulsion of osseous and disc material into the spinal canal, and significant spinal canal stenosis compared to the prior MRI from 6/17/2015. These findings appear similar to the CT abdomen and pelvis exam from 8/29/2015.3.Additional foci of osteomyelitis are again demonstrated involving the T12 and L3 vertebral bodies.4.Persistent paravertebral and pre vertebral inflammation and phlegmon but without visible abscess formation.These findings were discussed with the primary physician (Dr. Stephenson Pager 5731) at the time of the findings by Dr. Veronesi of the Radiology service.