Hosting 718 files, 2916 images, and 4 contributors.

 
Random Case

Fanconi Anemia
Joseph Junewick, MD FACR
over 5 years ago
Enter A Workflow
Standard2   Academic2

Please choose a workflow. A standard workflow allows you to browse the repository with full case detail; the academic workflow allows you to browse the repository with limited case detail revealed. Double click on the images to launch image viewer.

ARSt Case Repository

Osteomyelitis-Discitis

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 4 years ago
Updated: about 1 year ago
Tags: PEDS
Modality/Study Types: CR MR
Activities:
Adobe32 PDF Imagej32 ImageJA

History

Teenager with low back pain for one month prior to imaging.


Case Images


Diagnosis

Osteomyelitis-Discitis

Findings

MR 2/26 – T2 hyper intensity of anterior-superior L3 vertebral body
MR 3/6 – Decreased height and T2 signal of anterior L2-L3 disc space with increasing marrow edema in the superior aspect of the L3 vertebral body
MR 3/16 – Fluid in anterior L2-L3 disc space. Marrow edema and post-gadolinium blush in L3 and to a lesser extent inferior L2 vertebral bodies

CR 3/6 – Normal
CR 4/8 – Loss of anterior disc space and irregularity of endplates at L2-L3
CR 5/1 – Progressive loss of disc space and endplate collapse

Discussion

The classic presentation of discitis is back pain and refusal to walk. While considered infectious, a causative organism is isolated in only 1/3 of patients. Typically, patients are male, about 3 years of age, and have a history of previous trauma. Spinal osteomyelitis has similar symptoms to disci tis although more severe and accompanied by fever. It is usually related to hematogenous spread of S. aureus or gram negative bacteria. Discitis is often found in the lumbar region, L3-L4 and L4-L5. Vertebral osteomyelitis presents in older children, about 8 years of age, has more protracted course of disease and can occur anywhere in the spinal column. Spinal osteomyelitis can be catastrophic in neonates and immunocompromised. Symptoms for both entities are usually present for several weeks before radiographic findings are evident; therefore if clinically suspected, MR should be employed early in the clinical course. Complications of osteomyelitis-discitis include kyphosis, poor longitudinal growth and vertebral fusion.

Reference

Crowley JJ, Slovis TL, and Mooney JF. Infections of the veterbrae and disk spaces. Cafe’s Pediatric Diagnostic Imaging, 11th Ed 2008.



Corporate Office: 616.363.7272, 3264 North Evergreen Drive, Grand Rapids, MI 49525

Spectrum Health Helen Devos Childrens Hospital GE HealthCare