0:01

This is a patient who had been treated for back pain

0:05

with facet blocks by one of the pain management

0:09

specialists at an outside institution.

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The patient presented with severe back pain with fever.

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On the T1-weighted scan, we see a process which is

0:21

leading to infiltration of the posterior epidural fat.

0:26

Here's our epidural fat as the bright signal intensity

0:29

above and below the level of interest,

0:31

which is the L3-L4 level.

0:33

On the T2-weighted scan, we see that this is leading

0:37

to compression of the thecal sac anteriorly, and there

0:40

appears to be an area of high signal intensity.

0:43

Again, associated with the posterior elements.

0:45

When we look on the post-gadolinium T1-weighted scan,

0:49

we now can see a peripherally rim-enhancing lesion, which

0:53

has central absence of contrast enhancement, associated

0:57

with some mild enhancement of the nerve roots at the

1:00

same level. If you go into the paraspinal soft tissues,

1:04

we see this necrotic collection posterior

1:08

to the posterior elements.

1:10

We want to look at that on the T2 weighted

1:12

and post-gadolinium axial scans.

1:16

So here we see that this is a process which is extending

1:21

from where they were doing the nerve root blocks or the

1:25

facet blocks, into the paraspinal musculature, and from

1:30

there, into the epidural space, compressing the thecal sac.

1:34

Not only that, but we also see that the psoas muscle

1:37

on the right side is also involved.

1:39

On the post-gadolinium axial scan, we have the collection

1:45

which is seen peripherally enhancing as an

1:48

abscess in the posterior epidural space,

1:51

abscess formation in the paraspinal

1:53

musculature posteriorly,

1:56

as well as abscess formation in the psoas muscle.

2:00

There's inflammation which is extending

2:02

into the neural foramen.

2:03

And when we scan at the level

2:06

of the maximum compression,

2:08

we also see that the nerve roots are

2:10

showing contrast enhancement.

2:12

So this is a patient with an abscess, which is leading

2:17

to meningitis, as well as arachnoiditis and neuritis

2:21

on the same patient.