PMC8356238_01
A T2-weighted image showing a high-intensity area at the L4/5 intervertebral disc ( ) and an epidural abscess ( ).
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We diagnosed septic shock, pyogenic spondylitis at L4/5, and an epidural abscess (Fig. 1).
A contrast-enhanced computed tomography scan showing air around the vascular graft ( ).
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A contrast-enhanced CT examination at that time showed perigraft air, which raised suspicion for an infected vascular graft (Fig. 2).
A contrast-enhanced computed tomography scan, showing a vascular graft (circle) that had migrated into the duodenum ( ), raising suspicion of an aorto-enteric fistula and vascular graft infection.
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The blood culture revealed streptococcus, and the contrast-enhanced CT findings were suspicious for aorto-enteric fistula and vascular graft infection (Fig. 3).
Abnormal uptake of fluorodeoxyglucose at L3 ( ) and the vascular graft ( ). The diagnosis was pyogenic spondylitis, vascular graft infection, and an aorto-enteric fistula.
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We diagnosed pyogenic spondylitis, vascular graft infection, and an aortoenteric fistula (Fig. 4). In this case, we could not detect vascular graft infection on MRI because it did not show any signal change in the area where FDG accumulated on FDG-PET/CT scans ( Fig. 4, 6).
An outline of the antimicrobial and surgical treatment provided, the causative organism, and fluctuations in the C-reactive protein level over time.. ABPC/SBT: Ampicillin/Sulbactam, CEZ: Cefazolin, CLDM: Clindamycin, CTRX: Ceftriaxone, IPM/CS: Imipenem/Cilastatin, LVFX: Levofloxacin, MEPM: Meropenem, MINO: Minocycline, RFP: Rifampicin, ST: sulfamethoxazole-trimethoprim, VCM: Vancomycin, MRSA: Methicillin-resistant Staphylococcus aureus, MSSA: Methicillin-sensitive Staphylococcus aureus
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Fig. 5 shows the antibiotic and antifungal agents used for this patient.
(a) Magnetic resonance imaging with T2 sagittal, (b) magnetic resonance imaging with T1 coronal, (c) magnetic resonance imaging with T2 coronal, (d) magnetic resonance imaging with a diffusion-weighted image (DWI). Magnetic resonance imaging showing no signal change in the area where FDG-PTE/CT accumulated FDG.
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In this case, we could not detect vascular graft infection on MRI because it did not show any signal change in the area where FDG accumulated on FDG-PET/CT scans ( Fig. 4, 6).