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Vertebral osteomyelitis and diskitis with presacral abscess

Padro DTP - MedPix (2012)

View Article: MedPix Image - MedPix Case

Affiliation: Walter Reed National Military Medical Center

ABSTRACT

Diagnosis: Vertebral osteomyelitis and diskitis with presacral abscess

History: 62 y/o woman presented to the ED with progressively worsening back pain for six weeks. She remembers straining her back when she was gardening. She treated herself with motrin, but because of a planned shoulder surgery went to her PCM (knowing she’d have to stop the NSAIDs) and was switched to Percocet which seemed to help. Her shoulder surgery went well, but she notes worsening back pain ever since then especially over the last two weeks. She went to the ED multiple times for severe pain and at least once three weeks ago she was noted to have fever of 102 as well as an elevated ESR (105). She was presumptively diagnosed with PMR and started on prednisone and referred to Rheumatology. She was seen by both family medicine and Rheumatology who agreed she likely did not have PMR and the steroids were discontinued, however she continued to have progressive lower back pain now with intermittent radicular symptoms. An MRI was ordered to be done routinely as an outpatient. She denies weakness, saddle anesthesia, fecal or urinary incontinence, rashes, joint pain, or n/v/d.

Findings: • CT: CT images at 5 mm collimation were obtained with oral and intravenous contrast material. -The findings most compatible with L5-S1 discitis/osteomyelitis with superior S1 endplate osteolysis. Slight widening of the L5- S1 intervertebral disc space. There is a presacral rim enhancing fluid collection measuring a 6.1 x 4.2 x 8.8 cm, measuring in the AP, transverse and craniocaudal dimensions, respectively. This fluid collection spans from the level of the mid L5 vertebral body to the level of inferior S3 vertebral body. -There are multilevel degenerative changes of the lumbar spine with vacuum disk phenomenon at L3 -- L4 and mild disc space narrowing at this level. • MRI:IMPRESSION: -Diskitis osteomyelitis at L5-S1 with large prevertebral fluid collection consistent with abscess. -Intermediate signal intensity in the anterior epidural space versus within epidural venous plexus L5 to S1. This could represent a small subdural abscess versus phlegmonous change; differential within epidural venous plexus.

Ddx: -Multiple myeloma -Diskitis/Osteomyletis -Metastatic spinal lesion -Degenerative spinal disease -Subdural abscess -Compression Fracture -subdural abscess -presacral abscess -vacuum disk phenomenon

Dxhow: Biopsy and Culture of presacral mass (Fusobacterium sp.)

Exam: Gen: Well appearing female in NAD CV: RRR, III/VI systolic blowing murmur best heard at the RUSB, no radiation to the carotids, no JVD Pulm: CTAB no w/r/r Abd: NABS, NT/ND Back: No ttp, negative straight leg raise, negative FABER bilaterally Ext: No c/c/e Neuro: 2+ DTRs bilaterally CBC: 16.6/12.1/36.1/589 Ne 81 B8 BMP: 133/3.6/94/30/11/0.7>119 Ca 10.2 TP 7.1 Alb 4.0 AST 10 ALT 13 ALP 76 tbili 0.3 UA: LE small, 3 WBC, 1 RBC o/w negative BCx (Collected 28Jun): pending UACx: pending 09Jun 13Jun 25Jun 28Jun 28Jun ESR 105 99 91 98 93 15Jun 25Jun 28Jun 28Jun CRP 8.01 8.87 7.62 8.58 Previous Rheum w/u Jo-1 Extractable Nuclear Ab <0.20 Ribonucleoprotein Extractable Nuclear Ab 0.20 SCL-70 Extractable Nuclear Ab <0.20 SS-A Ab <0.20 SS-B Ab <0.20 Smith Extractable Nuclear Ab <0.20 Nuclear Ab Negative Anti-CCP Negative Rheumatoid factor 10.2 04Jan HbA1c 5.7

No MeSH data available.


The findings most compatible with L5-S1 discitis/osteomyelitis with superior S1 endplate osteolysis.  Slight widening of the L5 -- S1 intervertebral disc space.  There is a presacral rim enhancing fluid  collection measuring a 6.1 x 4.2 x 8.8 cm, measuring in the AP, transverse and craniocaudal dimensions, respectively.  This fluid collection (abs) spans from the level of the mid L5 vertebral body to the level of inferior S3 vertebral body.
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MPX1245_synpic58087: The findings most compatible with L5-S1 discitis/osteomyelitis with superior S1 endplate osteolysis. Slight widening of the L5 -- S1 intervertebral disc space. There is a presacral rim enhancing fluid collection measuring a 6.1 x 4.2 x 8.8 cm, measuring in the AP, transverse and craniocaudal dimensions, respectively. This fluid collection (abs) spans from the level of the mid L5 vertebral body to the level of inferior S3 vertebral body.


Vertebral osteomyelitis and diskitis with presacral abscess

Padro DTP - MedPix (2012)

The findings most compatible with L5-S1 discitis/osteomyelitis with superior S1 endplate osteolysis.  Slight widening of the L5 -- S1 intervertebral disc space.  There is a presacral rim enhancing fluid  collection measuring a 6.1 x 4.2 x 8.8 cm, measuring in the AP, transverse and craniocaudal dimensions, respectively.  This fluid collection (abs) spans from the level of the mid L5 vertebral body to the level of inferior S3 vertebral body.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1245&req=5

MPX1245_synpic58087: The findings most compatible with L5-S1 discitis/osteomyelitis with superior S1 endplate osteolysis. Slight widening of the L5 -- S1 intervertebral disc space. There is a presacral rim enhancing fluid collection measuring a 6.1 x 4.2 x 8.8 cm, measuring in the AP, transverse and craniocaudal dimensions, respectively. This fluid collection (abs) spans from the level of the mid L5 vertebral body to the level of inferior S3 vertebral body.

View Article: MedPix Image - MedPix Case

Affiliation: Walter Reed National Military Medical Center

ABSTRACT

Diagnosis: Vertebral osteomyelitis and diskitis with presacral abscess

History: 62 y/o woman presented to the ED with progressively worsening back pain for six weeks. She remembers straining her back when she was gardening. She treated herself with motrin, but because of a planned shoulder surgery went to her PCM (knowing she’d have to stop the NSAIDs) and was switched to Percocet which seemed to help. Her shoulder surgery went well, but she notes worsening back pain ever since then especially over the last two weeks. She went to the ED multiple times for severe pain and at least once three weeks ago she was noted to have fever of 102 as well as an elevated ESR (105). She was presumptively diagnosed with PMR and started on prednisone and referred to Rheumatology. She was seen by both family medicine and Rheumatology who agreed she likely did not have PMR and the steroids were discontinued, however she continued to have progressive lower back pain now with intermittent radicular symptoms. An MRI was ordered to be done routinely as an outpatient. She denies weakness, saddle anesthesia, fecal or urinary incontinence, rashes, joint pain, or n/v/d.

Findings: • CT: CT images at 5 mm collimation were obtained with oral and intravenous contrast material. -The findings most compatible with L5-S1 discitis/osteomyelitis with superior S1 endplate osteolysis. Slight widening of the L5- S1 intervertebral disc space. There is a presacral rim enhancing fluid collection measuring a 6.1 x 4.2 x 8.8 cm, measuring in the AP, transverse and craniocaudal dimensions, respectively. This fluid collection spans from the level of the mid L5 vertebral body to the level of inferior S3 vertebral body. -There are multilevel degenerative changes of the lumbar spine with vacuum disk phenomenon at L3 -- L4 and mild disc space narrowing at this level. • MRI:IMPRESSION: -Diskitis osteomyelitis at L5-S1 with large prevertebral fluid collection consistent with abscess. -Intermediate signal intensity in the anterior epidural space versus within epidural venous plexus L5 to S1. This could represent a small subdural abscess versus phlegmonous change; differential within epidural venous plexus.

Ddx: -Multiple myeloma -Diskitis/Osteomyletis -Metastatic spinal lesion -Degenerative spinal disease -Subdural abscess -Compression Fracture -subdural abscess -presacral abscess -vacuum disk phenomenon

Dxhow: Biopsy and Culture of presacral mass (Fusobacterium sp.)

Exam: Gen: Well appearing female in NAD CV: RRR, III/VI systolic blowing murmur best heard at the RUSB, no radiation to the carotids, no JVD Pulm: CTAB no w/r/r Abd: NABS, NT/ND Back: No ttp, negative straight leg raise, negative FABER bilaterally Ext: No c/c/e Neuro: 2+ DTRs bilaterally CBC: 16.6/12.1/36.1/589 Ne 81 B8 BMP: 133/3.6/94/30/11/0.7>119 Ca 10.2 TP 7.1 Alb 4.0 AST 10 ALT 13 ALP 76 tbili 0.3 UA: LE small, 3 WBC, 1 RBC o/w negative BCx (Collected 28Jun): pending UACx: pending 09Jun 13Jun 25Jun 28Jun 28Jun ESR 105 99 91 98 93 15Jun 25Jun 28Jun 28Jun CRP 8.01 8.87 7.62 8.58 Previous Rheum w/u Jo-1 Extractable Nuclear Ab <0.20 Ribonucleoprotein Extractable Nuclear Ab 0.20 SCL-70 Extractable Nuclear Ab <0.20 SS-A Ab <0.20 SS-B Ab <0.20 Smith Extractable Nuclear Ab <0.20 Nuclear Ab Negative Anti-CCP Negative Rheumatoid factor 10.2 04Jan HbA1c 5.7

No MeSH data available.