PMC7451159_01
Preoperative emergency MRI without gadolinium. In (a), the sagittal T1-weighted image provides suboptimal visualization of epidural abscess. In (b), the sagittal T2-weighted image demonstrates a longitudinally oriented mass-like lesion in the anterior epidural space spreading between the posterior wall of L4 and L5. In (c), the axial T2-weighted image demonstrates right side epidural abscess compressing both the cauda equina and right L5 and S1 emergent nerve roots.
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F1
Laboratory studies showed a high white blood cell count of 19.79 x 103/ml, while the emergent lumbar MRI without gadolinium showed an anterior epidural L4-L5-S1 empyema/abscess (e.g., low signal on T1- and a high signal in T2-weighted images) with marked thecal sac/root compression [Figure 1].
Three days postoperative MRI without gadolinium. In (a), the sagittal T1-weighted image, in (b), the sagittal T2-weighted image, in (c), the axial T2-weighted image demonstrate marked reduction of the preoperative empyema mass at L4 and L5 level in the anterior epidural space with consensual reduction of the compression on the adjoining meningeal and neural structures.
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F2
The 3-day postoperative lumbar MRI documented adequate decompression of the cauda equina [Figure 2], and the remainder of the postoperative course was uneventful; 1 month postoperatively, she had residual 4/5 motor function in the right lower extremity without any residual sphincter dysfunction [Figure 3].
One month postoperative MRI. In (a), the sagittal T2-weighted image and in (b), the axial T2-weighted image demonstrates the complete resolution of the infectious process.
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F3
The 3-day postoperative lumbar MRI documented adequate decompression of the cauda equina [Figure 2], and the remainder of the postoperative course was uneventful; 1 month postoperatively, she had residual 4/5 motor function in the right lower extremity without any residual sphincter dysfunction [Figure 3].