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Chapter: Neuro

Subchapter: Spine (Read entire chapter)

Diagnosis: Epidural and paravertebral abscess with septic facet joint
Contrast enhanced CT of the lumbar spine shows multiple connected enhancing lobulated fluid collections within the right paravertebral musculature at the level of L3-L4 disc base which extends inferiorly to the level of mid aspect S2 vertebral body (white arrows and asterisks). This is consistent with a paravertebral abscess. Fluid collection abuts the facet joint on the right at level of L4-L5 (panel A and magnification panel E). At the level of L4 vertebral body, there is a 2 cm enhancing epidural fluid collection representing an epidural abscess (black arrows, panel C and magnification panel E). This epidural abscess results in moderate to severe mass effect on the thecal sac. Smaller collection is present in the left paravertebral soft tissues at the level of L5-S1 (black asterisk, panel B).

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