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45 year old gentleman presented with vague low back ache. An MRI was asked for to rule out lumbar disc disease.
MRI
Findings
- STIR hyperintense signals are seen involving the L3 and L4 vertebral bodies.
- breach of the anterior half of superior end plate of L4 with a fluid signal intensity traversing the L3-4 disc superiorly to extend to the inferior end plate of L3.
- anteriorly it extends subligamentous to the right of midline mildly displacing the IVC anteriorly.
- no involvement of psoas muscles.
- no posterior extension into epidural space.
- no other vertebral joint involvement.
- rest of the intervertebral discs and lumbar vertebrae are normal.
Key points
- Imaging features are typical of spondylodiscitis.
- This patient is of Mediterranean origin and lab investigations revealed positivity for Brucellosis.
- Brucella spondylodiscitis has a predilection for lumbar spine and tends to present late in view of vague symptoms.
Read more
- Brucellosis – Radiopaedia
- Al-Shahed, Mona S., et al. “Imaging features of musculoskeletal brucellosis.” Radiographics 14.2 (1994): 333-348.
- Hong, Sung Hwan, et al. “MR Imaging Assessment of the Spine: Infection or an Imitation? 1.”Radiographics 29.2 (2009): 599-612.