Osteomyelitis

Findings:

Multiple sagittal MR images demonstrate abnormal marrow signal and enhancement involving the L4 and L5 vertebral bodies, associated with abnormal enhancement extending into the lateral paraspinal soft tissues. The L4-5 disc is spared.

Differential diagnosis:

Osteomyelitis, metastatic neoplasm, discogenic endplate changes.

Discussion:

The marrow alterations in this case are patchy and poorly defined, as opposed to nodular marrow alterations seen with metastatic disease. Extent of edema signal and poorly defined enhancement into adjacent soft tissues raises the more likely diagnosis of infection. Infectious processess often involve the annulus and disc first before bone involvement, but not always. TB is commonly more centered on the bones than discs, but other organisms may also cause predominantly bone involvement. Biopsy and blood cultures yielded E. faecium.

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