A Unique Presentation of a Large, Seven-segment, Spinal Epidural Abscess in a Patient with a Pleural Empyema

Abstract

Spinal epidural abscesses are insidious infections spread via hematologic, contiguous, or iatrogenic routes. On average, spinal epidural abscesses span two to four vertebral segments and are most commonly localized to the thoracic region. Fever, back pain, and neurological deficits are the most common clinical manifestations. However, the triad of these findings are not always detected. Patients may present with subtle symptoms leading to misdiagnosis and poor prognosis. We present a case of a large, anteriorly located, spinal epidural abscess in a patient originally admitted for dyspnea and confusion.

Keywords: epidural abscess; infection; motor weakness; paresthesias; pyogenic infection; spinal canal; spinal cord compression; spinal epidural abscess.

Figure 1. Axial image from non-contrast CT of the chest showing a large, loculated, left-sided pleural effusion bordering the posterolateral margin of the heart (arrows).

CT = computed tomography

Figure 2. Sagittal T1 post-contrast image of the cervicothoracic spine showing a fluid collection in the anterior epidural space from C3 to T2 (white arrows), and prevertebral fluid collection from C4 to T2 (red arrows).

MRI = magnetic resonance imaging