The Spine Journal
Holospinal epidural abscess in a child patient: magnetic resonance imaging findings A 5-year-old male patient was admitted to our hospital with fever lasting 2 days, numbness in feet, and walking disorder. There were restrictions of movement in both lower extremities, and two dermal sinus openings were found 3 cm and 10 cm cranial to anal region in physical examination. There were no risk factors in patient history, and infection markers such as sedimentation, C-reactive protein (CRP), and procalcitonin values were elevated. Spinal magnetic resonance imaging was performed, and there was a fluid collection consistent with abscesses extending between C4 and L4 vertebrae segments, showing continuity along the posterolateral spinal cord, having a maximum thickness of 15 mm and millimetric air intensities on lumbar segments, hypointense on T1-weighted images (WI), hyperintense on T2-WI, and showing peripheral enhancement after intravenous contrast administration. Likewise, an additional fluid collection consistent with epidural
-
(2015)
-
abscess in similar nature was seen, 4-cm long and 1 cm in diameter, starting from L4 segment and showing continuity to the S2 segment (Figs. 1 and 2). Under general anesthesia, L2 and L3 bilateral partial hemi-laminotomy was performed with posterior approach, and abscess with dirty appearance was drained. Enterococcus, tuberculosis, and anaerobic bacteria were proliferated in culture sample. Spinal epidural space extends in a vertical plane, includes arterial and venous structures, and surrounded with fatty tissue. Abscess spreads across this space while it expands and usually involves multiple segments [1]. It can be seen on every age, but it is more frequent in fifthand seventh-decade male patients. There is usually an underlying reason such as history of interventions relevant to vertebral canal, intravenous drug use, immunosuppression, and so forth. Holospinal extension in pediatric patient is rather rare, and there are only a few cases in literature [2,3]. References [1] Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM 2007;101:1–12.
Fig. 1. Cervical sagittal T1-weighted (Left), T2-weighted (Middle), and postcontrast T1-weighted (Right) images show a fluid collection consistent with epidural abscesses starting from C4 vertebrae, hypointense on T1-weighted image, hyperintense on T2-weighted image and showing peripheral enhancement after intravenous contrast administration (arrows). http://dx.doi.org/10.1016/j.spinee.2015.06.064 1529-9430/Ó 2015 Elsevier Inc. All rights reserved.
2
M. Koplay et al. / The Spine Journal
-
(2015)
-
Fig. 2. Sagittal thoracic T2- (A), lumbar T2- (B) and postcontrast T1- (C, D) weighted images show a fluid collection consistent with epidural abscesses showing continuity along the posterolateral spinal cord and ending in level L4 vertebrae (long arrows). In addition, these images show epidural abscesses showing continuity along the anterolateral spinal cord extending between L4 and S2 vertebrae segments (arrowheads).
[2] Ghosh PS, Loddenkemper T, Blanco MB, Marks M, Sabella C, Ghosh D. Holocord spinal epidural abscess. J Child Neurol 2009;24: 768–71. [3] Gorchynski J, Hwang J, McLaughlin T. A methicillin-resistant Staphylococcus aureus-positive holospinal epidural abscess. Am J Emerg Med 2009;27:514.e7–9.
Mustafa Koplay, MDa Mesut Sivri, MDa Melike Keser Emiroglu, MDb _ Ibrahim Guler, MDa Hakan Karabagli, MDc Yahya Paksoy, MDa a Department of Radiology Medical Faculty Selcuk University
The Central Campus 42075, Konya, Turkey b Department of Pediatric Infection Disease Medical Faculty Selcuk University Konya, Turkey c Department of Neurosurgery Medical Faculty of Selcuk University Konya, Turkey FDA device/drug status: Not applicable. Author disclosures: MK: Nothing to disclose. MS: Nothing to disclose. _ MKE: Nothing to disclose. IG: Nothing to disclose. YP: Nothing to disclose.
Holospinal epidural abscess in a child patient: magnetic resonance imaging findings A 5-year-old male patient was admitted to our hospital with fever lasting 2 days, numbness in feet, and walking disorder. There were restrictions of movement in both lower extremities, and two dermal sinus openings were found 3 cm and 10 cm cranial to anal region in physical examination. There were no risk factors in patient history, and infection markers such as sedimentation, C-reactive protein (CRP), and procalcitonin values were elevated. Spinal magnetic resonance imaging was performed, and there was a fluid collection consistent with abscesses extending between C4 and L4 vertebrae segments, showing continuity along the posterolateral spinal cord, having a maximum thickness of 15 mm and millimetric air intensities on lumbar segments, hypointense on T1-weighted images (WI), hyperintense on T2-WI, and showing peripheral enhancement after intravenous contrast administration. Likewise, an additional fluid collection consistent with epidural
-
(2015)
-
abscess in similar nature was seen, 4-cm long and 1 cm in diameter, starting from L4 segment and showing continuity to the S2 segment (Figs. 1 and 2). Under general anesthesia, L2 and L3 bilateral partial hemi-laminotomy was performed with posterior approach, and abscess with dirty appearance was drained. Enterococcus, tuberculosis, and anaerobic bacteria were proliferated in culture sample. Spinal epidural space extends in a vertical plane, includes arterial and venous structures, and surrounded with fatty tissue. Abscess spreads across this space while it expands and usually involves multiple segments [1]. It can be seen on every age, but it is more frequent in fifthand seventh-decade male patients. There is usually an underlying reason such as history of interventions relevant to vertebral canal, intravenous drug use, immunosuppression, and so forth. Holospinal extension in pediatric patient is rather rare, and there are only a few cases in literature [2,3]. References [1] Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM 2007;101:1–12.
Fig. 1. Cervical sagittal T1-weighted (Left), T2-weighted (Middle), and postcontrast T1-weighted (Right) images show a fluid collection consistent with epidural abscesses starting from C4 vertebrae, hypointense on T1-weighted image, hyperintense on T2-weighted image and showing peripheral enhancement after intravenous contrast administration (arrows). http://dx.doi.org/10.1016/j.spinee.2015.06.064 1529-9430/Ó 2015 Elsevier Inc. All rights reserved.
2
M. Koplay et al. / The Spine Journal
-
(2015)
-
Fig. 2. Sagittal thoracic T2- (A), lumbar T2- (B) and postcontrast T1- (C, D) weighted images show a fluid collection consistent with epidural abscesses showing continuity along the posterolateral spinal cord and ending in level L4 vertebrae (long arrows). In addition, these images show epidural abscesses showing continuity along the anterolateral spinal cord extending between L4 and S2 vertebrae segments (arrowheads).
[2] Ghosh PS, Loddenkemper T, Blanco MB, Marks M, Sabella C, Ghosh D. Holocord spinal epidural abscess. J Child Neurol 2009;24: 768–71. [3] Gorchynski J, Hwang J, McLaughlin T. A methicillin-resistant Staphylococcus aureus-positive holospinal epidural abscess. Am J Emerg Med 2009;27:514.e7–9.
Mustafa Koplay, MDa Mesut Sivri, MDa Melike Keser Emiroglu, MDb _ Ibrahim Guler, MDa Hakan Karabagli, MDc Yahya Paksoy, MDa a Department of Radiology Medical Faculty Selcuk University
The Central Campus 42075, Konya, Turkey b Department of Pediatric Infection Disease Medical Faculty Selcuk University Konya, Turkey c Department of Neurosurgery Medical Faculty of Selcuk University Konya, Turkey FDA device/drug status: Not applicable. Author disclosures: MK: Nothing to disclose. MS: Nothing to disclose. _ MKE: Nothing to disclose. IG: Nothing to disclose. YP: Nothing to disclose.
