Neuro_MR_CS: 55 F, neck pain

MRI CERVICAL SPINE WITH AND WITHOUT CONTRAST:

 

CLINICAL HISTORY: 55 years of age, Female, concern for retropharyngeal and/or bony infection in setting of prior retropharyngeal phlegmon complicated by MSSA bacteremia. Evaluate for 

osteomyelitis.

FINDINGS:

Alignment: Loss of the normal lordosis, likely degenerative.

Bone marrow: Increased STIR signal within the dens, the left lateral mass of C1, and the anterior arch of C1.

Vertebrae: Ill-defined cortical erosive change of the dens and the anterior arch of C1, better demonstrated on prior CT neck. A small amount of fluid is seen within the atlantodental interval, likely corresponding to mild widening of the atlantodental interval better seen on prior CT neck.

C2-C3: Mild right neural foraminal narrowing. Mild left neural foraminal narrowing. Moderate disc degenerative disease.

C3-C4: Moderate right neural foraminal narrowing. Mild left neural foraminal narrowing. Moderate disc degenerative disease.

C4-C5: Moderate right neural foraminal narrowing. Moderate left neural foraminal narrowing. Mild disc degenerative disease with mild posterior disc bulge.

C5-C6: Moderate right neural foraminal narrowing. Moderate left neural foraminal narrowing. Mild disc degenerative disease with mild posterior disc bulge.

C6-C7: Moderate right neural foraminal narrowing.  Moderate left neural foraminal narrowing. Mild disc degenerative disease with mild posterior disc bulge.

C7-T1: Mild disc degenerative disease.

Cord: No abnormal cord signal. No abnormal epidural or leptomeningeal 

enhancement.

Extra-vertebral soft tissues: Moderate edema of the prevertebral soft tissues, most prominent anterior to C1/C2. There is extensive enhancement of the prevertebral soft tissues corresponding to the region of edema. Mild soft tissue enhancement is also seen adjacent to the posterior arch of C1. Of note, the degree of prevertebral soft tissue edema and enhancement appears significantly decreased compared to prior MR neck.

Visualized brain: Normal.

Additional comment: Prominent cervical lymph nodes, likely reactive.

IMPRESSION:

1.  Erosive change of the dens/anterior arch of C1, with widening of the atlantodental interval and moderate prevertebral soft tissue edema/enhancement as described above. Given patient's reported history of MSSA bacteremia, findings are concerning for atlantodental osteomyelitis.