Reason: Patient with diabetic foot ulcer, bacteremia, and likely osteomyelitis of right foot with severe lower back pain on the left side. Our current differential for the back pain is osteomyelitis of lumbar spine, infectious abdominal abscess, nephrolithiasis History: Back pain on left side Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. There is heterogeneous low T1 marrow signal which is nonspecific and may be related to anemia patient's or chronic renal disease. The conus medullaris is normal in position.There is ill-defined extrathecal fluid collection involving the lumbar spinal canal extending from the T12-L1 level to the L5-S1 level. There is a component extending from the T12-L1 to the L1-L2 level without prior for enhancement and appears to be within the subdural space. There is ventral displacement of the cauda equina nerve roots at this level. More inferiorly from the L2-L3 level to the L5-S1 level, the fluid collection appears more heterogeneous, demonstrates mild heterogeneous enhancement, and appears to involve the epidural space and possibly also the subdural space. There is moderate to severe narrowing of the thecal sac worst at the L3-L4 and L4-L5 levels which is at least in part related to a background of congenital spinal canal narrowing and epidural lipomatosis.There is facet arthropathy at the L4-L5 level with a 9 x 6 mm structure involving the dorsal epidural space at the L4-L5 level which may represent a synovial cyst.There is minimal bilateral L3-L4 neural foraminal narrowing and moderate bilateral L4-L5 neural foraminal stenosis related to disc bulge and facet arthropathy. Remainder of the neural foramina are patent.. Paraspinous soft tissues demonstrate no paraspinous fluid collections or abscess.
1. There is ill-defined thin extrathecal fluid collection involving the lumbar spinal canal extending from the T12-L1 level to the L5-S1 level. Superior component extending from the T12-L1 to the L1-L2 level without peripheral enhancement appears to be within the subdural space and may represent CSF versus old hematoma. There is ventral displacement of the cauda equina nerve roots at this level. More inferiorly from the L2-L3 level to the L5-S1 level, the fluid collection appears more heterogeneous, demonstrates mild heterogeneous enhancement, and appears to involve the dorsal epidural space and possibly the subdural space. Overall the enhancement associated with the thin fluid collection may represent infection/abscess or chronic blood products. Correlate for history of any lumbar puncture or other spinal injection. There is moderate to severe narrowing of the lumbar thecal sac at the L3-L4 and L4-L5 levels, which is at least in part related to a background of congenital spinal canal narrowing and epidural lipomatosis with the superimposed thin fluid collection contributing to the stenosis. 2. No evidence of discitis-osteomyelitis or paraspinous fluid collection.3. L4-L5 facet arthropathy with 9 x 6 mm structure in the epidural space at this level which may represent a synovial cyst or given the adjacent abnormal epidural enhancement described above, infection is not excluded. 4. Moderate L4-L5 neural foraminal stenosis bilaterally on a degenerative basis.