PMC7569184_01
Chest radiograph shows opacification in the right lower lung field with a blunt costophrenic angle (arrow) suggesting pleural effusion. Consolidations (arrowheads) are also noted in right lower lung field.
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A chest x-ray revealed opacification of the right lower lung field and blunting of the right costophrenic angle, suggesting pleural effusion (Fig. 1).
Contrast enhanced axial (a) and coronal (b) CT images show loculated pleural effusion (asterisks) and pleural thickening (arrow) with atelectasis (arrowheads). Magnified axial (c) and coronal (d) CT images show paravertebral soft tissue infiltration (arrows) in the T8-9 levels.
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Chest computed tomography (CT) showed a loculated right pleural effusion with pleural thickening, as well as passive atelectasis in right lower lobe (Fig. 2a and b). Interestingly, after careful review of the chest CT images, a mild paravertebral soft tissue infiltration was demonstrated at the T8-9 levels (Fig. 2c and d).
MRI images of the T8-9 levels. T1 weighted sagittal image (a) shows low signal intensity in the bone marrow of the T8-9 vertebral body (arrows). T2 weighted coronal image with fat suppression (b) shows high signal intensity in bone marrow (arrows) and intervertebral disc (short arrow) and paravertebral soft tissue (arrowheads). Loculated pleural effusion was also demonstrated (asterisks). Fat-suppressed contrast enhanced T1 weighted sagittal and axial images (c-d) show enhancement of bone marrow (arrows) and paraspinal soft tissue (arrowheads). Contiguous enhancement spreading to adjacent right pleura (blank arrowheads) from paravertebral soft tissue is also demonstrated. Phlegmon (blank arrow) causing mild central canal compromise is also noted in the epidural space.
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T1-weighted image also demonstrated that enhancement of the paraspinal soft tissue contiguously spread to the adjacent right pleura (Fig. 3). These MRI findings suggested that inflammation due to spondylodiscitis of the thoracic vertebrae had spread to the adjacent right pleura, which may have caused the exudative pleural effusion.