PMC5909092_01
Lumbosacral spinal sagittal post-gadolinium T1-weighted MRI (a), T2-weighted MRI (b), and axial post-gadolinium T1-weighted MRI (c) showing a posterior epidural abscess extending from L4 to S1 with cauda equina compression. Note the ring enhancement
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F1
The MRI showed an oblong posterior epidural lesion compressing the thecal sac from the L4 to S1 levels; it was hypointense on T1 and hyperintense on T2-weighted images, which demonstrated ring enhancement with gadolinium injection [Figure 1].
Operative view demonstrating an encapsulated epidural collection with purulent material inside (a). Appearance of the abscess wall adhering to a filamentous foreign body (textiloma) (b)
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F2
At surgery, there was an encapsulated posterior epidural abscess that required drainage [Figure 2a]. There was also a granulomatous lesion (unsuspected surgical cottonoid) noted at the antero-inferior part of the abscess wall (at the level of S1); it was completely removed along with marginal thick fibrotic capsular tissue [Figure 2b].
Hematoxylin-eosin-stained tissue showing histopathologic features of the granulomatous lesion that contain polynuclear and multinucleated giant cells around cut fibers (arrows) (Medium power magnification)
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F3
The histopathological examination confirmed a textiloma; there was chronic inflammation and fibrosis surrounding the retained cottonoid [Figure 3].