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Paraspinal Abscess


KEY FACTS

Terminology

  • Paraspinal phlegmon surrounding peripherally enhancing fluid collections

Imaging

  • Pre vertebral/ para vertebral space

  • Multiple or multiloculated collections along muscle plane

  • NECT

    • Amorphous low-density intramuscular collection

    • Calcified psoas abscesses characteristic of tuberculous paraspinal abscess

    • Endplate destruction

  • MR

    • Iso- to hypointense on T1WI

    • Hyperintense fluid collection and surrounding muscle on T2WI and STIR

    • Diffuse enhancement: Phlegmon

    • Peripherally enhancing fluid collection(s): Abscess

Top Differential Diagnoses

  • Neoplasm, primary or metastatic

  • Retroperitoneal hematoma

  • Extramedullary hematopoiesis

Pathology

  • Most common pathogens: Staphylococcus aureus, Mycobacterium tuberculosis, Escherichia coli

  • Predisposing factors

    • Intravenous drug abuse

    • Immunocompromised state

  • Etiology

    • Direct extension from adjacent infection

    • Transcutaneous infection of deep tissue

    • Hematogenous spread from distant sites

Clinical Issues

  • Fever (50%) at presentation

  • Back pain and tenderness

  • ↑ erythrocyte sedimentation rate, ↑ white blood cell count

Diagnostic Checklist

  • Evaluate adjacent vertebral bodies and intervertebral disc spaces for spondylodiscitis

  • Peripherally enhancing collection in paravertebral soft tissue with associated spondylitis characteristic of paraspinal abscess

Axial graphic through a lumbar disc space demonstrates an extensive abscess infiltrating bilateral psoas muscles
and epidural space
. Abnormal retroperitoneal lymph nodes are also present
.

Axial NECT depicts bilateral calcified paraspinal masses
in a patient with tuberculosis spondylodiscitis. Anterior aspect of the vertebral body adjacent to the subchondral plate is affected with spread to adjacent discs. Abscesses may descend down the sheath of the psoas and are typically calcified.

Sagittal CT (L) illustrates a low-density collection in the operative bed status post schwannoma resection. The collection has faint peripheral enhancement
. Sagittal T1WI C+ MR (R) in the same patient better delineates irregular peripheral enhancement
of the postoperative collection and enhancement in the neural foramen
. The patient presented with fever and leukocytosis.

Axial T1WI C+ MR shows a peripherally enhancing collection
in the left neural foramen operative site.

TERMINOLOGY

Abbreviations

  • Paraspinal abscess (PA)

Definitions

  • Infection of soft tissues surrounding spine

    • Phlegmon surrounding peripherally enhancing fluid collections

IMAGING

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