A close look at a transspatial thoracic spine abscess

This 55-year-old male patient has history of quadriplegia due to transsection of the upper cervical spinal cord (image 1, orange arrow). Within the last six months, the patient noticed an absence of muscle spasms from the lower lumbar and lower extremities.

At the level of the T11-T12 intervertebral disc space, large loculated fluid collection / abscess obliterates the central spinal canal and portions of the T11 and T12 vertebral bodies as well as extends to the posterior elements and soft tissues. Images 2 and 3 (red arrows) show the extent of the abscess extending from the prevertebral soft tissues through the intervertebral disc space, through the spinal canal, and into the posterior elements.

Fluid collection partially surrounds the descending aorta with edematous changes including the bodies of T11 and T12, and extends approximately two-thirds of the way of the L1 vertebral body. Abscess extends approximately from the level of T10 to L1 measuring 7.25cm in craniocaudal dimension (image 2, yellow line) and 2.00cm in anteroposterior dimension (image 2, blue line). The fluid component measures 7.09cm in the trans-sagittal dimension (image 2, pink line). Given the upper cervical spinal cord transsection, findings are consistent with an abscess likely related to underlying Charcot disease.

Image 4 shows the extent of the abscess (green arrow) obliterating the spinal canal, vertebral body, and posterior elements.