Epidural Abscess | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Epidural Abscess

Sagittal T2 (left, image 1) and T1 post contrast MRI (right, image 1) of the thoracic and lumbar spine show a large epidural abscess (arrow). Diffusion weighted image (left, image 2) and ADC map (right, image 2) confirm abscess with presence of restricted diffusion. Spinal epidural abscesses are rare. Most cases are idiopathic. However, it can be associated with adjacent infection, diabetes, intravenous drug use, or iatrogenic causes. Patients may present with severe back pain, fever, and neurologic symptoms.

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Axial (image 1) and sagittal (image 2) contrast-enhanced CT shows a large epidural abscess (arrow) with an air-fluid level and peripheral enhancement. The abscess is compressing the right frontal lobe. Coronal images displayed using bone windows (image 3) highlight opacification of the frontal sinuses, osteomyelitis (dashed arrow) of the roof of the right frontal sinus, and the large adjacent abscess with air-fluid level (arrowhead). Intracranial epidural abscesses are most commonly caused by sinusitis.

Final images: the left lesion is true restricted diffusion related to (embolic from the heart) acute infarction. The right is T2 shine through from edema related to rim enhancing masses which had central restricted diffusion (not shown) due to abscesses from aspergillus.

T2, STIR and Post Gd images of MDR spinal tuberculosis with pre/para vertebral abscesses, epidural granulation tissue and cord compression.

Axial (image 1) and coronal (image 2) CT scans of the neck show an abscess (arrow) in the region of the right palatine tonsil. Peritonsillar abscesses are the most common deep head and neck infections presented in the emergency department. Patients with a peritonsillar abscess experience escalating pain and odynophagia.

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