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case_images: Discitis-osteomyelitis changes on CT. Comparing to prior CT L-spine from March 2022 (A), a CT L-spine from August 2022 (B) shows new prominent erosive endplate changes at L1-L2 (arrows) and some erosion at L3-L4, concerning for discitis-osteomyelitis.
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case_images: Incidentally, CT revealed discitis-osteomyelitis changes involving L1-2 and to a lesser extent L3-4 (Fig. 1).
case_images: MRI confirms discitis-osteomyelitis changes observed on CT. Sagittal STIR (A) and post-contrast images (B) demonstrate prominent edema and enhancement of the L1 and L2 vertebral bodies and within the L1-L2 intervertebral disc, compatible with discitis-osteomyelitis. There is also mild edema and enhancement of the L3-L4 vertebral endplates, which in conjunction with new erosive endplate changes seen on the CT, are suggestive of early discitis-osteomyelitis at this level. C. Axial STIR image demonstrates a small heterogeneous collection in the right psoas muscle. D. There is no definite rim-enhancement on the Axial T1 post-contrast image. Therefore, this is most compatible with a phlegmon, rather than a frank abscess. Axial T1 post-contrast image also demonstrates diffuse enhancement of the bilateral psoas muscles compatible with inflammatory change.
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case_images: MRI confirmed these findings and exposed a small paraspinal phlegmon measuring 1.4 x 1.3 cm determined to be inaccessible by interventional radiology for sampling (Fig. 2).