Presentation
L hip pain worse on movement. Normal radiographs of the pelvis and hips. Normal left hip ultrasound. “? Abdominal cause.”
Patient Data
Paravertebral and epidural soft-tissue mass at L2/L3 narrowing the spinal canal and L2 root foramina, more marked on the left. Small gas locules in the disc and prevertebral mass. End-plate destruction at the left margin of L2 and L3. Minor heterogeneous enlargement of the right psoas muscle.
Normal left hip. Non-distended bladder.
Incidental L1 hemangioma, infra-renal aortic aneurysm, left adrenal adenoma, non-obstructing right renal calculi and paraumbilical hernia.
Left lateral end-plate destruction at L2/L3.
“MSSA bacteremia.”
L2/3 spondylodiscitis.
Endplate depression.
L2 laminectomy.
Fracture dislocation at L2/L3: L2 is displaced to the right, associated with a displaced fracture of the inferior facet of L3 and disruption and widening of the left sided facet joint.
Case Discussion
Spondylodiscitis presenting with pain in the L2 dermatome and developing cauda equina syndrome, treated by appropriate antibiotic regime and urgent decompression and drainage.
Subsequent fracture dislocation.
The enlarging right psoas abscess was subsequently drained percutaneously.
This case illustrates the importance of considering sources of referred pain, also the importance of systematic CT evaluation. Spinal disease one of the more commonly missed diagnoses.
Unable to process the form. Check for errors and try again.