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Age: 46

Sex: Female

Indication: Lower back pain

Save ("V")

Case #9


Findings

  • T2/STIR hyperintense signal and enhancement in the right L4-L5 facet joint extending into the adjacent articular pillars and L4 and L5 pedicles
  • T2/STIR hyperintense signal and enhancement in the surrounding right posterior paraspinal soft tissues and musculature without peripherally enhancing collection
  • T2/STIR hyperintense signal and enhancement in the anterior aspects of the L2 inferior endplate and L3 superior endplate without intervening disc signal abnormality
  • Mild multilevel facet hypertrophy without significant spinal canal or neural foraminal stenosis
  • No epidural collection


Diagnosis

  • Septic facet arthritis

Sample Report

Findings consistent with septic arthritis involving the right L4-L5 facet joint with associated osteomyelitis involving the adjacent articular pillars and L4 and L5 pedicles. No epidural abscess or significant associated spinal canal or neural foraminal compromise.

Adjacent myositis without soft tissue abscess.

T2/STIR hyperintense signal and enhancement in the anterior aspects of the L2 inferior endplate and L3 superior endplate, which is favored degenerative in etiology given lack of abnormal disc signal. Recommend attention on followup imaging.

Mild multilevel facet hypertrophy without significant spinal canal or neural foraminal stenosis.


Discussion

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Images

Right L4-L5 facet joint effusion (red arrows) with surrounding edema (as noted on the sagittal STIR image on the left) and enhancement (as noted on the axial post-contrast image on the right) in the adjacent bones and soft tissues.



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