Multiple spinal epidural abscesses extending to the whole spinal canal

Solomou, Ekaterini; Maragkos, Markos; Kotsarini, C.; Konstantinou, D.; Maraziotis, Theodoros

doi:10.1016/j.mri.2004.01.072

Cited by 16 publications

(12 citation statements)

References 7 publications

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“…The abscess is usually only one or two vertebral bodies in length and most commonly affects the lumbosacral spine6 8, but other regions can be affected and, in extreme cases, the abscess can extend throughout the whole spinal canal 9–11. It is usually secondary to discitis, osteomyelitis or pyomyositis of the erector spinae muscles 12 .…”

Section: Discussionmentioning

confidence: 99%

Spontaneous abscess of the lumbar spine presenting as subacute back pain

Dickson

Warren²,

Chapman³

et al. 2010

Case Reports

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SummaryA 52-year-old lady was admitted with back pain, fever and reduced sensation in her left leg. Soon after admission she developed acute urinary retention. She underwent urgent MRI of the spine which showed an epidural abscess compressing the thecal sac which was treated with neurosurgical decompression and intravenous/oral antibiotics. Cultures from theatre grew Staphylococcus aureus sensitive to flucloxacillin. After 12 weeks of intravenous/oral antibiotics, she was discharged without any neurological disability.

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Section: Discussionmentioning

confidence: 99%

Spontaneous abscess of the lumbar spine presenting as subacute back pain

Dickson

Warren²,

Chapman³

et al. 2010

Case Reports

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“…Although epidural abscess usually extends over three to four vertebrae, it can involve the whole spine and is known as panspinal infection. 2,26,27 MRI findings of pyogenic spondylodiscitis include high signal on T 2 weighted images and low signal on T 1 weighted images with contrast enhancement. T 2 weighted images demonstrate spinal cord compression and abnormal cord signal.…”

Section: Patterns Of Extension Of Pyogenic Abscess and Pus Collectionmentioning

confidence: 99%

Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections

Moritani

Kim²,

Capizzano³

et al. 2014

BJR

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The incidence of spinal infections has increased in the past two decades, owing to the increasing number of elderly patients, immunocompromised conditions, spinal surgery and instrumentation, vascular access and intravenous drug use. Conventional MRI is the gold standard for diagnostic imaging; however, there are still a significant number of misdiagnosed cases. Diffusion-weighted imaging (DWI) with a b-value of 1000 and apparent diffusion coefficient (ADC) maps provide early and accurate detection of abscess and pus collection. Pyogenic infections are classified into four types of extension based on MRI and DWI findings: (1) epidural/paraspinal abscess with spondylodiscitis, (2) epidural/ paraspinal abscess with facet joint infection, (3) epidural/paraspinal abscess without concomitant spondylodiscitis or facet joint infection and (4) intradural abscess (subdural abscess, purulent meningitis and spinal cord abscess). DWI easily detects abscesses and demonstrates the extension, multiplicity and remote disseminated infection. DWI is often a key image in the differential diagnosis. Important differential diagnoses include epidural, subdural or subarachnoid haemorrhage, cerebrospinal fluid leak, disc herniation, synovial cyst, granulation tissue, intra-or extradural tumour and post-surgical fluid collections. DWI and the ADC values are affected by susceptibility artefacts, incomplete fat suppression and volume-averaging artefacts. Recognition of artefacts is essential when interpreting DWI of spinal and paraspinal infections. DWI is not only useful for the diagnosis but also for the treatment planning of pyogenic and nonpyogenic spinal infections.Spinal and paraspinal infections include vertebral osteomyelitis, spondylodiscitis, infectious facet arthropathy, epidural infections, meningitis, myelitis and infections of paraspinal soft tissue and musculature. Evidence of spinal infections has been discovered in the remains of prehistoric humans from 7000 BC. 1 The incidence has increased in the past two decades, owing to the rising number of elderly patients, immunocompromised conditions, spinal surgery and instrumentation, vascular access and intravenous drug use.1-4 Despite advances in medical knowledge, imaging modalities and surgical interventions, the diagnosis of this entity is still challenging since the clinical features can be subtle and misleading. MRI including post-contrast studies is the gold standard for diagnostic imaging. However, although MRI has relatively high diagnostic sensitivity, specificity and accuracy, there are still a significant number of challenging cases. In such cases, diagnostic delays and suboptimal management can result in irreversible paralysis, critical sepsis and even death.Diffusion-weighted imaging (DWI) has proven to be a useful tool for the diagnosis of a variety of intracranial infections especially in the detection of brain abscesses and pus collections, which encompass subdural and epidural empyema, purulent meningitis and ventriculitis. [5][6][7][8] Therefore, DWI ...

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“…19 SEA generally extends over three to four vertebrae but, in rare cases, involves the entire spine, resulting in the socalled pan-spinal infection. 20,21 Lumbar puncture and CSF studies are less important in the diagnosis of SEA. Both gram staining and culture of CSF have a poor yield, and results of microscopy and biochemical analysis are non-specific.…”

Section: Investigationsmentioning

confidence: 99%

Spinal epidural abscess with myelitis and meningitis caused byStreptococcus pneumoniaein a young child

Bhattacharya

Joshi

2011

The Journal of Spinal Cord Medicine

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Background: Spinal epidural abscess (SEA) in children is a rare infectious emergency warranting prompt intervention. Predisposing factors include immunosuppression, spinal procedures, and local site infections such as vertebral osteomyelitis and paraspinal abscess. Staphylococcus aureus is the most common isolate. Design: Case report and literature review. Findings: A 2.5-year-old boy with tetraparesis was found to have an SEA in the posterior lumbar epidural space with evidence of meningitis and myelitis on MRI spine in the absence of any local or systemic predisposing factors or spinal procedures. Streptococcus pneumoniae was isolated from the evacuated pus. Conclusions: Definitive treatment of SEA is a combination of surgical decompression and iv antibiotics. Timely management limits the extent of neurological deficit.

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Multiple spinal epidural abscesses extending to the whole spinal canal

Cited by 16 publications

References 7 publications

Spontaneous abscess of the lumbar spine presenting as subacute back pain

Spontaneous abscess of the lumbar spine presenting as subacute back pain

Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections

Spinal epidural abscess with myelitis and meningitis caused byStreptococcus pneumoniaein a young child

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