Cervical Discitis and Osteomyelitis

Findings:

Sagittal MR images demonstrate extensive abnormal signal of the C3 and C4 vertebral bodies. After gadolinium administration, there is extensive abnormal enhancement of these segments with prevertebral and ventral epidural signal abnormality. There is irregular destruction of the C3-C4 disk space. Diffusion weighted imaging demonstrates restricted diffusion associated with this process.

Discussion:

nDifferential Diagnosis
nDiscitis/osteomyelitis, discogenic endplate changes, metastatic neoplasm
nFeatures
nEndplate edema, enhancement, destruction
nParavertebral inflammatory/phlegmon/abscess
nEpidural abscess/phlegmon
nT2 disc hyperintensity
nClinical
nHematogenous- lung, UTI, skin (IVDA)
nStaph, strep, E. coli, Proteus
nDialysis pts with renal spondyloarthropathy at cervical levels may sim discitis but low on T2WI (?amyloid)

 

 

 

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