case_images: PMC11002916_01
case_images: MRI (T2w images sagittal (a) and axial (b); T1w  gadolinium images sagittal (c) and axial (d)); and CT-scan images (sagittal in bone window (e) and axial in soft tissue window (f)) of the lumbosacral spine before treatment, showing marked degenerative changes in the lower lumbar spine but additionally pronounced contrast enhancement in the paravertebral tissue and psoas muscle (white arrows) with gas containing small abscesses prevertebral (black arrows) hinting to a masked pyogenic spondylodiscitis with little involvement of the intervertebral space.
case_images: jbji-9-59-f01.jpg
case_images: PMC11002916_01_jbji-9-59-f01.jpg
case_images: Ch1.F1
case_images: A magnetic resonance imaging (MRI) of the lumbosacral spine showed inflammatory changes paravertebrally and inside the psoas muscle on the left side at level L3/4 without clear involvement of the intervertebral disc compartment yet, hinting at a (because of marked degenerative changes) masked spondylodiscitis with little involvement of the intervertebral space (Fig. 1).
case_images: MRI (T2w images sagittal (a) and axial (b); T1w  gadolinium images sagittal (c) and axial (d)) of the lumbosacral spine after treatment, showing marked improvement of the infectious changes in the prevertebral and paravertebral tissue (white arrows).
case_images: jbji-9-59-f02.jpg
case_images: PMC11002916_01_jbji-9-59-f02.jpg
case_images: Ch1.F2
case_images: However, the imaging also revealed clear involvement of intervertebral disc and the adjacent vertebral bodies, so spondylodiscitis was retrospectively proven (Fig. 2).