PMC4898071_01
13-year-old wth paraspinal abscesses. Non-contrast enhanced CT imaging of the renal collecting system for the evaluation of nephrolithiasis was negative for calcification. Hypodensity was noted in the left paraspinal musculature on axial imaging using soft tissue window levels (W342/L56) (Figure 1A) but not as well delineated on sagittal images (Figure 1B) using the same display settings. The post contrast axial and transverse CT images demonstrate peripheral wall enhancement (white arrow) consistent with paraspinal abscess (Figure 1C). The reconstructed sagittal imaging demonstrates multilevel abscesses (white arrow).
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The CT scan was negative for nephrolithiasis but did suggest multiple small hypodensity foci within the left paraspinal muscles (Figure 1A & 1B). With this new information, a CT of the abdomen and pelvis using 2 milligrams (mg)/kilogram (kg) of Isovue 180 contrast (Bracco Diagnostic, Inc., Princeton, NJ) better defined the regions of hypodensity as rim enhancing fluid consistent with abscesses (Figure 1C & 1D).
13-year-old wth paraspinal abscesses. Post Gadolinium lumbar spine MRI in the transverse (Figure 2A, T1 FSE TR/TE 550/10.168 W/L 2470/1065) and sagittal plane (Figure 2B & 2C, T1 FSE TR/TE 466.664/18.708; W/L 1385/692) confirm the paraspinal musculature abscesses (white arrows) and epidural abscess (black arrow).
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An enhanced thoracolumbar spine magnetic resonance imaging (MRI) study utilizing 0.2 mg/kg of Magnevist (Bayer Healthcare Pharmaceuticals, Wayne, NJ) was performed for improved sensitivity in the evaluation of spinal cord abnormalities and confirmed multilevel thoracolumbar dorsal paraspinal and epidural abscess (Figure 2).