DM, HTN, dementia, bipolar disorder and recent diagnosis of MSSA bacteremia, endocarditis and T11-12 osteomyelitis, currently being treated with IV Vancomycin. Patient had outpatient CT lumbar spine for persistent back pain with new finding of L4-5 disc and end plate destruction concerning for new foci of osteomyelitis. There are endplate erosions and surrounding bone marrow edema and enhancement at the T11-12 and L4-5 levels, extending into the adjacent paraspinal soft tissues. There is also disc space narrowing and fluid, as well as mild epidural enhancement at these levels, but no evidence of abscess. There is no compression of the imaged portions of the spinal cord, which displays normal signal characteristics. There is patchy bone marrow edema and enhancement in the L1 and L2 vertebral bodies with a prominent anterior disc osteophyte complex and depression of the L2 superior endplate. There is also irregularity and enhancement associated with a right L2-3 facet joint, with epidural extension. There are small disc bulges at L4-5 and L5-S1 with mild spinal canal narrowing at L4-5, mild effacement of the left lateral recess at L5-S1, as well as severe left and moderate right neural foraminal narrowing due to superimposed inflammatory tissue at L4-5 and moderate bilateral neural foraminal narrowing at L5-S1. Likewise, there is effacement of the bilateral T11-12 neural foramina due to inflamed soft tissues. There is no spondylolisthesis. There is a globular lesion between the infrarenal aorta and the inferior vena cava that measures up to 30 mm in diameter with what may be interval flow voids. There is a filter in the adjacent inferior vena cava. There are partly imaged left renal cysts.
1. Findings suggestive of discitis-osteomyelitis at L4-5 and L5-S1 with associated phlegmon, as well as septic arthritis with phlegmon involving the right L2-3 facet joint. Patchy bone marrow edema and enhancement in the L1 and L2 vertebral bodies with a prominent anterior disc osteophyte complex may represent additional osteomyelitis, although this may also be attributable to underlying degenerative disease bone marrow effects. 2. Degenerative spondylosis at L4-5 and L5-S1 with mild spinal canal narrowing at L4-5, mild effacement of the left lateral recess at L5-S1, as well as severe left and moderate right neural foraminal narrowing due to superimposed inflammatory tissue at L4-5 and moderate bilateral neural foraminal narrowing at L5-S1.3. A globular lesion between the infrarenal aorta and the inferior vena cava that measures up to 30 mm in diameter with what may be interval flow voids, suggestive of a possible pseudoaneurysm, perhaps secondary to thrombophlebitis. Doppler ultrasound of this region may be useful for further evaluation.