Female, 42 years old, with MRSA endocarditis and continued positive blood cultures despite appropriate therapy. Evaluate for epidural abscess. Cervical:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement, edema or pathologic enhancement is seen. The visualized spinal cord shows normal signal intensity and morphology. No epidural abnormalities are suspected. The intervertebral discs are preserved with no significant spinal canal or foraminal stenosis seen.Thoracic:Alignment is anatomic. Vertebral body height and morphology are within normal limits. Degenerative fatty endplate signal change is seen anteriorly from the T8 level to the T12 level. At T11, there is also small focus of enhancement at the anterior superior endplate but no osseous destruction and no involvement of the intervertebral disc. A clustering of mildly prominent retrocrural lymph nodes is seen adjacent to T11. The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are seen. Intervertebral discs are preserved with no spinal canal or foraminal stenosis. Small bilateral pleural effusions and scattered airspace opacities are noted in the lungs.Lumbar:Alignment is anatomic. Vertebral body height and morphology are within normal limits. Fatty endplate signal change is seen along the inferior endplate of L1 and minimally along the superior endplate of L3. No pathologic marrow enhancement is observed. The distal spinal cord, conus and nerve roots of the cauda equina are within normal limits. No epidural abnormalities are suspected. The intervertebral discs are preserved with no evidence of spinal canal or foraminal stenosis.
1.No evidence of an epidural abscess is seen.2.No definite findings of discitis osteomyelitis are noted.3.Fatty endplate signal alteration is demonstrated at multiple levels in the lower thoracic and upper lumbar spine. Such findings are likely chronic and degenerative in nature.4.Only one small focus of abnormal marrow enhancement is seen along the anterior superior endplate of T11. In the context of chronic endplate degenerative signal at multiple additional levels, this finding is favored to represent a more inflammatory phase of the degeneration. Adjacent slightly prominent lymph nodes are, however, seen. If clinical concern for spine infection persists, a follow-up examination can be considered in one to two weeks.