Presentation
Weakness in lower limbs and hyperreflexia.
Patient Data
A large cavitary lesion seen at the left apico-posterior segment of the left upper lobe, with internal fluid signal intensity areas/liquefaction and surrounding irregular area of consolidation.
Extension of the infective/inflammatory to the process to the posterior dorsal epidural space through the left lateral dorsal exit foramina at the level of to C7/D1 down to D2/D3.
There is posterior enhancing epidural fluid collection and thickening extending from C7 down to D9.
The D1 displaying heterogeneous mostly low signal in T1 and heterogeneous high signal in T2 with abnormal enhancement in the post contrast study.
Abnormal soft tissue thickening and enhancement of the pre and paraspinal soft tissue at D1 down to D3 with involvement of the posterior aspect of the ribs and of the costovertebral junction more at the left side.
There is two focal areas of cord malacia seen opposite to D7 and D8/9 disc level.
Case Discussion
Pathologically proven MRSA staphylococcus aureus with left upper lobar pulmonary abscess complicated by pyogenic spondylitis and epidural collection. Two focal areas of cord malacia.
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