Status post prior removal of an intrathecal pain pump and catheter system and T11 level abscess. Postoperative changes are again seen from previous bilateral T11 laminectomy with partial resection of the T10 spinous process. There is an interval decreased thickness of the residual extradural collection within the laminectomy bed, now measuring 32 mm CC, compared to previous 41 mm CC. On axial images, the most confluent area of fluid signal now measures 16 x 5 mm on 8/47, compared to previous 14 x 12 mm at the mid T11 level. Additional fluid is identified again extending posteriorly with surrounding likely granulation tissue related enhancement along the prior surgical tract, into the deep subcutaneous fat, although overall decreased in extent. There is slight decreased ventral convexity of the collection, although there remains effacement of the CSF within the thecal sac at this level without significant mass effect upon the cord.There is decreased degree of enhancement of the dura along the surgical bed, with significant increased confluence of enhancement within the posterior subcutaneous and paraspinal soft tissues. There is persistent focal cord enhancement measuring up to 6 x 4 mm in greatest axial dimensions. Associated T2 hyperintense cord signal abnormality has significantly improved with perhaps subtle abnormality extending from upper T10 to mid T12 levels, with more conspicuous residual T2 hyperintensity seen at this level on the sagittal images which may relate to myelomalacia versus residual cord edema. Cord caliber has mildly diminished at the affected levels.A prominent T1/T2 hyperintense hemangioma is present in the left T2 vertebral body. Incidental note is made of a stable oval nonenhancing T2 hyperintense structure associated with the right T7 rib posteriorly which could relate to a cystic schwannoma or other cystic lesion measuring 6 x 17 mm.
1. Interval expected evolution of previously seen postoperative changes. Minimal residual extradural fluid collection seen along the laminectomy bed at the T11 level with resolved mass effect upon the cord at this level although there remains CSF effacement.2. Persistent intramedullary cord enhancement at the T11 level, with significant further reduction in associated cord signal abnormality likely relating to resolving cord edema with possible development of myelomalacia.