CTICasesDiscitis Osteomyelitis with Paraspinal Abscess
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Imaging findings
A patient presenting with low back pain had a chest radiograph revealing an abnormal, bowed paraspinal line. A lateral radiograph further showed a poorly defined disk space at the affected level. Subsequent CT, initially performed as a PE study, clearly demonstrated a paraspinal abscess and evidence of chewed-up bone. MRI confirmed the diagnosis of discitis osteomyelitis. A disc biopsy grew out methicillin-sensitive *Staphylococcus*.
Key takeaways
This case serves as an excellent teaching example for recognizing subtle radiographic signs of serious spinal pathology on routine chest imaging. An abnormal paraspinal line and ill-defined disk spaces are critical clues for discitis osteomyelitis and associated abscess, emphasizing the importance of a comprehensive review of all structures on a chest radiograph, not just the lungs. The patient's presentation with back pain, leading to discovery on a PE study, highlights the need for vigilance.
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