E4860. Discitis-Osteomyelitis or Mimics? An Attempt to Enlighten This Dark Region
Authors
Mahmoud Shalaby;
Mercy Catholic Medical Center
Ahmed Moawad;
Mercy Catholic Medical Center
Madiha Aslam;
Mercy Catholic Medical Center
Salama Chaker;
Mercy Catholic Medical Center
Sergiy Kushchayev;
Lee Moffitt Cancer Center and Research Institute
Amir Honarmand;
Mercy Catholic Medical Center
Oleg Teytelboym;
Mercy Catholic Medical Center
Background
Discitis-osteomyelitis is a well-known, but challenging, disease to diagnose, due to subtle imaging findings that sometimes overlap with other noninfectious entities. To avoid devastating neurologic and musculoskeletal consequences, prompt and precise diagnosis is essential.
Educational Goals / Teaching Points
We will illustrate spine anatomy and provide a case-based overview of the radiological findings of early and advanced discitis-osteomyelitis in different imaging modalities and explain the features that can help to differentiate it from other noninfectious entities, such as spinal neuroarthropathy, degenerative disc disease, acute Schmorl’s node, hemodialysis-related spondyloarthropathy, Andersson lesions of spondylarthritis, spinal lymphoma, aggressive hemangioma, and SAPHO syndrome. Additionally, we will explain the differentiating imaging features of pyogenic disease from atypical infections, such as tuberculosis and fungi. Finally, to help in establishing the diagnosis, we will provide troubleshooting tips for ambiguous cases.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Discitis-osteomyelitis, spinal neuroarthropathy, degenerative disc disease, acute Schmorl’s node, hemodialysis-related spondyloarthropathy, Andersson lesions of spondylarthritis, spinal lymphoma, aggressive hemangioma, and SAPHO syndrome.
Conclusion
Spinal infection can typically involve the disc-endplate complex, facet joint, or epidural space. Paraspinal soft tissue edema and enhancement is one of the most sensitive signs of early discitis-osteomyelitis that can help in prompt detection of early infection, often preceding the osseous destructive changes. Different imaging features, such as vacuum phenomenon, claw sign on DWI, T1 and T2 hypointense deposits, and anterior and posterior compartment involvement provide helpful clues for considering noninfectious etiologies.
