Korean J Neurotrauma.  2015 Apr;11(1):18-21. 10.13004/kjnt.2015.11.1.18.

Pyogenic Intradural Abscess of Lumbar Spine: A Case Report

• Cheon JE
• Yang HJ
• Chung YN
• Park SB

• KMID: 2156087
• DOI: http://doi.org/10.13004/kjnt.2015.11.1.18

Abstract

We report a case of spinal intradural abscess which shows serial changes on magnetic resonance imaging (MRI). Well-encapsulated, rim-enhancing lesion with mass effect was visualized at ventral side of lumbar spinal canal on 17 days after initial negative MRI, which was thought to be epidural abscess. It was revealed to be intradural in location on operation and successfully treated by drainage and antibiotics. Follow-up MRI showed resolution of abscess. Clinical significance and pathogenesis of this case was briefly discussed.

Keyword

Intradural abscess; Lumbar spine; Magnetic resonance imaging; Drainage

MeSH Terms

Abscess*
Anti-Bacterial Agents
Drainage
Epidural Abscess
Follow-Up Studies
Magnetic Resonance Imaging
Spinal Canal
Spine*
Anti-Bacterial Agents

Figure

• 

  FIGURE 1 Initial magnetic resonance imaging of the lumbar spine. Precontrast T1-weighted images (A, C) and postcontrast T1-weighted images (B, D) depict irregular, linear enhancement in the epidural venous plexus at L4-5 and L5-S1 level (black arrows in B, white arrow in D). There was no abscess formation.

• 

  FIGURE 2 Preoperative follow-up magnetic resonance imaging obtained on 17th day of intravenous antibiotic treatment. Precontrast T1-weighted images (A) and postcontrast T1-weighted images (B-D) show elongated shape fluid collection with rim-enhancement at ventral side of spinal canal (arrows) at L2-4 level. On axial images at L2 (C) and L3-4 level (D) the abscess shows dorsally convex and mass effect on the dural sac mimicking epidural lesion (arrows).

• 

  FIGURE 3 Intraoperative photographs. A: Yellowish purulent material was oozing out (black arrow) between lumbar nerve roots (white asterisks) after opening of cyst wall. B: A part of cyst wall was grasped by forceps.

• 

  FIGURE 4 Follow-up magnetic resonance imaging (MRI) obtained 2 weeks after operation. Precontrast T1-weighted images (A) and postcontrast T1-weighted images (B-D) show near complete disappearance of intraspinal rim-enhancing lesion observed on preoperative MRI as described in Figure 2.

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