Fig. 1
Initial lumbar spine magnetic resonance imaging performed without gadolinium demonstrated extensive abnormal T2 hyperintensity of the L5 interspace (a and b, sagittal fat-saturated T2-weighted image and axial T2-weighted image at the L5 interspace) indicating discitis. A large multilobulated fluid collection was contiguous with the infected interspace indicating an abscess (arrow, a and b). Follow-up lumbar spine magnetic resonance imaging performed with gadolinium demonstrated extensive abnormal enhancement (c and d, post-gadolinium sagittal T1-weighted with fat saturation and axial T1-weighted images, respectively) and T2 hyperintensity (e and f, sagittal T2-weighted with fat saturation and axial T2-weighted at the L4 interspace) involving the L3 to L4, L4 to L5, and L5 to S1 interspaces. There is abnormal paraspinal and epidural enhancing phlegmon with a focal ventral epidural abscess (arrow, c and e) emanating from the L4 to L5 interspace. An additional abscess involving the left posterolateral soft tissues (arrow, d and f) was targeted during biopsy and yielded 10 cc of fluid