Spinal epidural apse

Özet

Spinal epidural apse, epidural aralıkta pürülan koleksiyon oluşmasıdır ve omurilik ya da kauda ekuina basısı nedeniyle zaman duyarlı bir tanıdır. BT spinal kanalda yer kaplayan bir lezyonu gösterebilir ancak niteliğini belirleyemeyebilir; epidural apseyi ve yayılımını değerlendirmede MR tercih edilen incelemedir. BT spinal kanaldaki lezyonun niteliğini belirleyemeyebilir; MR apsenin yerini ve yayılımını BT'den daha iyi gösterir. Geciken tanı kalıcı motor, duyu veya sfinkter işlev kaybına ilerleyebilir.

Faz ve pencere

Kontrastsız

BT spinal kanalda yer kaplayan bir lezyonu gösterebilir, ancak lezyonun niteliğini belirleyemeyebilir.

Kontrastlı

BT spinal kanalda yer kaplayan bir lezyon gösterebilir, ancak lezyonun niteliğini belirleyemeyebilir; MR apsenin yerini ve uzanımını BT’den daha iyi gösterir.

Kemik algoritması

BT'de eşlik eden vertebra destrüksiyonu görülebilir; ancak BT spinal kanal içindeki lezyonun niteliğini belirleyemeyebilir.

BT bulguları

• Kanal içi epidural yumuşak doku — epidural apse spinal kanalda yer kaplayan lezyon oluşturup dural tüpe bası yapabilir.
• Çevresel kontrastlanan odak — kontrastlı seride düşük atenüasyonlu merkez ve çevresel boyanma büyük apseyi destekleyebilir.
• Thekal kese basısı — spinal epidural apse dural kese üzerinde bası oluşturabilir.
• Paravertebral kaynak — psoas/paraspinal koleksiyonun veya enfekte disk-son plak seviyesinin kanala komşuluğu.
• Eşlik eden vertebral veya disk enfeksiyonu — epidural apseye komşu vertebra, disk ve paraspinal kaslarda inflamatuvar bulgular görülebilir.
• Posterior epidural odak — septik faset artritinde enfeksiyon faset ekleminden posterior epidural alana uzanabilir.
• Kraniokaudal yayılım — epidural apse birden fazla seviyeye uzanabilir; MR yayılımın yerini ve kapsamını BT'den daha iyi gösterir.
• MR’da epidural apse T2 ağırlıklı görüntülerde yüksek sinyalli içerik ve kontrast sonrası çevresel boyanma gösterebilir; difüzyon ağırlıklı görüntülerde içerik yüksek sinyalli olabilir.

Normalde

Spinal epidural alan yağ, arterler ve venöz pleksus içerir; spinal epidural apseyi değerlendirmede MR tercih edilen görüntüleme yöntemidir. BT spinal kanaldaki yer kaplayan lezyonun niteliğini belirleyemeyebilir; MR epidural apseyi değerlendirmede tercih edilen görüntüleme yöntemidir.

Ayırıcı tanı

Epidural flegmon

kontrastlı MR'da homojen/inflamatuvar boyanma yapar; apse evresinde sıvı merkezi ve çevresel duvar henüz oluşmamış olabilir.

Epidural hematom, spinal epidural apse için ayırıcı tanıda düşünülmelidir.

Epidural metastaz, spinal epidural apse için ayırıcı tanıda düşünülmelidir.

Disk hastalığı

ekstrüde veya yer değiştirmiş disk, spinal epidural apse için ayırıcı tanıda düşünülmelidir.

Epidural venöz pleksus, spinal epidural alanın normal anatomik içerikleri arasındadır.

Tuzaklar

• BT spinal kanaldaki yer kaplayan lezyonun niteliğini belirleyemeyebilir; epidural apse şüphesinde MR tercih edilen incelemedir.
• Epidural venöz pleksus spinal epidural alanın normal içeriklerindendir.
• MR apse yerini ve kraniokaudal uzanımını BT'den daha iyi gösterir; BT yayılımın kapsamını ortaya koyamayabilir.
• Eşlik eden vertebral destrüksiyon veya spondilodiskit bulgusu yokluğu epidural enfeksiyonu dışlamaz; apse faset eklemi veya hematojen yolla doğrudan epidural alanda gelişebilir.
• MR’da periferik ya da halka biçimli boyanma pürülan sıvı veya gerçek apseyi düşündürebilir; ayırıcı tanıda ekstrüde ya da yer değiştirmiş disk hastalığı da bulunur.

Kendini dene

1. Şiddetli sırt ağrısı ve ilerleyen nörolojik defisiti olan hastada BT tanısal değilse epidural apse şüphesinde hangi görüntüleme tercih edilmelidir?

   • Kontrastlı spinal MR
   • Tekrar kontrastsız BT
   • Yalnızca kemik sintigrafisi
   • Görüntüleme gerekmez
   Cevabı göster

   Kontrastlı spinal MR. MR, spinal epidural apse şüphesinde tercih edilen görüntüleme yöntemidir; BT spinal kanaldaki yer kaplayan lezyonun niteliğini belirleyemeyebilir.

2. Kontrastlı MR'da spinal epidural lezyonda çevresel boyanma ve dural kese basısı görülüyor. Bu bulgular en çok hangi tanıyı destekler?

   • Spinal epidural apse
   • Epidural hematom
   • Disk ekstrüzyonu
   • Epidural venöz pleksus
   Cevabı göster

   Spinal epidural apse. Epidural lezyonda çevresel veya halka biçimli boyanma pürülan sıvı ya da gerçek apse varlığını destekleyebilir; bu bulgu tek başına kesin tanı koydurmaz.

İlgili konular

• Tüberküloz spondilit (Pott hastalığı)
• Epidural flegmon
• Paraspinal ve psoas enfeksiyöz koleksiyon

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 28 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Long-Segment Ventral Spinal Epidural Abscesses Caused by Mycobacterium Tuberculosispmc.ncbi.nlm.nih.gov
2. Emergency surgery for a patient with a thoracic spinal epidural abscess: a case report and literature reviewpmc.ncbi.nlm.nih.gov
3. Spinal Epidural Abscess: A Review of Presentation, Management, and Medicolegal Implicationspmc.ncbi.nlm.nih.gov
4. Nocardial spinal epidural abscess with lumbar disc herniationpmc.ncbi.nlm.nih.gov
5. Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Managementpmc.ncbi.nlm.nih.gov
6. Management of Staphylococcus aureus Bacteremia: A Review.pubmed.ncbi.nlm.nih.gov
7. Spinal Epidural Abscess: Diagnosis, Management, and Outcomes.pubmed.ncbi.nlm.nih.gov
8. Spinal Epidural Abscess.pubmed.ncbi.nlm.nih.gov
9. Tropical myelopathies.pubmed.ncbi.nlm.nih.gov
10. Spinal epidural abscess.pubmed.ncbi.nlm.nih.gov
11. Emergency medicine updates: Evaluation and diagnosis of sepsis and septic shock.pubmed.ncbi.nlm.nih.gov
12. Update on spinal epidural abscess.pubmed.ncbi.nlm.nih.gov
13. Spinal epidural abscess.pubmed.ncbi.nlm.nih.gov
14. [Spinal Epidural Abscess].pubmed.ncbi.nlm.nih.gov
15. Spinal Emergencies in Primary Care Practice.pubmed.ncbi.nlm.nih.gov
16. Evaluation and Management of Pyogenic and Tubercular Spine Infections.pubmed.ncbi.nlm.nih.gov
17. Evaluation and management of spinal epidural abscess.pubmed.ncbi.nlm.nih.gov
18. Management of spinal infection: a review of the literature.pubmed.ncbi.nlm.nih.gov
19. Neisseria gonorrhoeae paravertebral abscess.pubmed.ncbi.nlm.nih.gov
20. Holospinal epidural abscesses - Institutional experience.pubmed.ncbi.nlm.nih.gov
21. Long-segment cervical brucellar epidural abscess limited by a disc barrier presenting with tetraparesis: A case report.pubmed.ncbi.nlm.nih.gov
22. Subacute anterior spontaneous spinal epidural hematoma at the thoracolumbar junction: A diagnostic confounder following necrotizing staphylococcal pneumonia.pubmed.ncbi.nlm.nih.gov
23. Thoracic myelopathy secondary to epidural scarring with associated infection following spinal cord stimulation implantation.pubmed.ncbi.nlm.nih.gov
24. Spinal Epidural Abscess Following Spinal Anesthesia in a Bacteremic Patient: A Case Report.pubmed.ncbi.nlm.nih.gov
25. Differentiating Tuberculous and Pyogenic Spondylodiscitis: Part II: MRI/CT Features, Prediction Models, and the Role of PET/CT-A Narrative Review.pubmed.ncbi.nlm.nih.gov
26. Initial Negative MRI Spine and Persistent Staphylococcus aureus Bacteraemia Lead to Delayed Diagnosis of Lumbar Spondylodiscitis and Epidural Abscess: A Case Report.pubmed.ncbi.nlm.nih.gov
27. A transformer-based deep learning algorithm for diagnosing spinal infections on axial non-contrast computed tomography images: a dual-center retrospective study.pubmed.ncbi.nlm.nih.gov
28. Decompressive Laminectomy for Neurological Complications of Spondylodiscitis: A Case Series of 15 Patients.pubmed.ncbi.nlm.nih.gov
29. A Case of Spinal Epidural Abscess and Paraplegia After Group A Streptococcal Pharyngitis.pubmed.ncbi.nlm.nih.gov
30. Central Nervous System Involvement in Acute Myeloid Leukemia: From Pathophysiology to Neuroradiologic Features and the Emerging Role of Artificial Intelligence.pubmed.ncbi.nlm.nih.gov
31. Role of the Ear in Meningitis: A Narrative Review of Neuroimaging.pubmed.ncbi.nlm.nih.gov
32. The management of space-occupying cyst in the tumor bed after brain tumor surgery: a case series integrated with literature synthesis.pubmed.ncbi.nlm.nih.gov
33. Multifocal tuberculosis with cerebral, spinal, pulmonary and abdominal involvement in a 16-year-old girl: A radiological case report.pubmed.ncbi.nlm.nih.gov
34. Imaging for Pediatric Head and Neck Emergencies: Critical Insights.pubmed.ncbi.nlm.nih.gov
35. Contained rupture of a thoracic aortic aneurysm at the diaphragmatic hiatus: A case report.pubmed.ncbi.nlm.nih.gov
36. Lumbar spinal brucellosis presenting as an atypical epidural abscess.pubmed.ncbi.nlm.nih.gov
37. Emergency surgical management of nontraumatic pathologic spinal pain diagnosed in the emergency department.pubmed.ncbi.nlm.nih.gov
38. Challenges in diagnosing malignant lymphoma involving the spine: illustrative cases.pubmed.ncbi.nlm.nih.gov
39. Spinal granulocytic sarcoma with both extradural and intradural involvement: a case report.pubmed.ncbi.nlm.nih.gov
40. Orbital NUT carcinoma with intracranial extension.pubmed.ncbi.nlm.nih.gov
41. Magnetic resonance imaging of the spine.pubmed.ncbi.nlm.nih.gov
42. Spinal Subdural Haematoma.pubmed.ncbi.nlm.nih.gov
43. Potentially low cost solution to extend use of early generation computed tomography.pubmed.ncbi.nlm.nih.gov
44. Preoperative Posterior Paraspinal Fatty Infiltration and an Exploratory Axial Muscle Imaging Phenotype in Surgically Treated Metastatic Epidural Spinal Cord Compression: A Retrospective Cohort Study.pubmed.ncbi.nlm.nih.gov
45. Diffuse large B-cell lymphoma mimicking musculoskeletal nontuberculous mycobacterial infection: A fatal diagnostic challenge.pubmed.ncbi.nlm.nih.gov
46. <i>Mycobacteroides abscessus</i> complex vertebral osteomyelitis and discitis of the thoracolumbar spine: a systematic review of management and outcomes with illustrative case.pubmed.ncbi.nlm.nih.gov
47. Prevotella denticola Bacteremic Spondylodiscitis and Epidural Abscess Associated With a Periapical Lesion: A Case Report.pubmed.ncbi.nlm.nih.gov
48. Lumbar Facet Joint Septic Arthritis Complicated by Spinal Epidural Abscess in Adolescents: Two Case Reports and a Literature Review.pubmed.ncbi.nlm.nih.gov
49. Complete Neurological Recovery Following Combined Anterior-Posterior Cervical Corpectomy and Circumferential Stabilization for Severe Cervical Tuberculosis with Grade IV C3-C4 Spondylolisthesis: A Rare Case Report from Somalia.pubmed.ncbi.nlm.nih.gov
50. International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
51. Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.pubmed.ncbi.nlm.nih.gov
52. Presumed cervical subperiosteal vertebral hemorrhage in nine greyhounds.pubmed.ncbi.nlm.nih.gov
53. Deciding when and when not to reconstruct the orbit: How I do it.pubmed.ncbi.nlm.nih.gov
54. CT evaluation of pediatric craniocervical distraction injuries: a comprehensive review of morphometric parameters and practical applications.pubmed.ncbi.nlm.nih.gov
55. Imaging persistent spinal pain syndrome and spine surgery complications: an interpretation guide for radiologists.pubmed.ncbi.nlm.nih.gov
56. An Eleven-Point Ultrasound-Guided Fascia Hydrorelease Protocol for Non-Odontogenic Toothache and Orofacial Pain: A Clinical Protocol.pubmed.ncbi.nlm.nih.gov
57. The use of a biocompatible carbon fiber implant for cervical and lumbar spine fusion in the treatment of spondylodiscitis: a case report.pubmed.ncbi.nlm.nih.gov
58. Clinical, laboratory, and MRI features differentiating tuberculous and pyogenic spondylodiscitis: a propensity score-matched analysis.pubmed.ncbi.nlm.nih.gov
59. Giant Abdominal Haematoma and Rapid Multidrug-Resistant Infection After Low-Molecular-Weight Heparin in a Patient With COVID-19 and Rheumatoid Arthritis.pubmed.ncbi.nlm.nih.gov
60. Intracranial venous thrombosis imaging by anatomical location: an educational review with mimics and diagnostic pitfalls.pubmed.ncbi.nlm.nih.gov
61. Helcococcus kunzii as a rare etiological agent of spondylodiscitis partially managed with oral antibiotic therapy in a patient with diabetes mellitus: a case report.pubmed.ncbi.nlm.nih.gov
62. Purely osteolytic bone lesions in the early osteoarticular phase of synovitis, acne, pustulosis, hyperostosis and osteitis syndrome.pubmed.ncbi.nlm.nih.gov
63. Progressive Spastic Paraparesis Caused by Thoracic Spinal Epidural Lipomatosis: A Case Report and Systematic Review.pubmed.ncbi.nlm.nih.gov
64. Postoperative brain abscesses and infections after neurosurgery: Clinical characteristics, risk profiles, microbiological findings, and longitudinal DWI and ADC MRI analysis.pubmed.ncbi.nlm.nih.gov
65. Recurring Paralysis and a Race Against Time: A Case of Cauda Equina Syndrome With Delayed Diagnosis and Incomplete Neurological Recovery.pubmed.ncbi.nlm.nih.gov
66. Spinal lesions: a comprehensive radiologic overview.pubmed.ncbi.nlm.nih.gov
67. A Primer on Anatomy, Biophysics, Pathology, Imaging and Treatment of the Intervertebral Disc and the Anterior Spinal Column: The Discogenic, Intervertebral, Spinal Column (DISC) ASPN Workgroup.pubmed.ncbi.nlm.nih.gov
68. Unusual Spinal Epidural and Paraspinal Venous Engorgement Secondary to Hepatosplenic Schistosomiasis: A Rare Cause of Severe Low Back Pain.pubmed.ncbi.nlm.nih.gov
69. Differentiating Tuberculous and Pyogenic Spondylodiscitis: Part I-Epidemiology, Clinical Features, Laboratory Markers, and Tissue-Based Diagnosis.pubmed.ncbi.nlm.nih.gov
70. Machine Learning-Based Interpretable Screening for Osteoporosis in Tuberculosis Spondylitis Patients Using Blood Test Data: Development and External Validation of a Novel Web-Based Risk Calculator with Explainable Artificial Intelligence (XAI).pubmed.ncbi.nlm.nih.gov
71. The space of Retzius: anatomy, imaging features, and patterns of disease spread.pubmed.ncbi.nlm.nih.gov
72. Thoracic trauma WSES-AAST guidelines.pubmed.ncbi.nlm.nih.gov
73. Epilepsy in Association with Giant Skull Base Tumors: A Retrospective Case Series of Giant Skull Base Tumors in the Anterior and Middle Fossa.pubmed.ncbi.nlm.nih.gov
74. Image-Guided Breast Interventions: Biopsy and Beyond.pubmed.ncbi.nlm.nih.gov
75. Lumbosacral Spinal Tuberculosis: Clinical Spectrum, Diagnostic Challenges, and Short-Term Management Outcomes in an Elderly Cohort.pubmed.ncbi.nlm.nih.gov
76. Polymethyl Methacrylate (PMMA) Cement as an Interbody Spacer in Pyogenic Spondylodiscitis: Results of a Scoping Review.pubmed.ncbi.nlm.nih.gov
77. Pediatric nasal dermoid sinus cysts: advances in pathogenesis, management strategies, and translational research-a multidisciplinary management perspective.pubmed.ncbi.nlm.nih.gov
78. Development and Proof-of-Concept Evaluation of a Structured Reporting Template for Emergency Radiology Using Synthetic Cases.pubmed.ncbi.nlm.nih.gov
79. The Correlation Between Paraspinal Muscular Morphology, Spinopelvic Parameters, and Back Pain: A Comparative Cohort Study.pubmed.ncbi.nlm.nih.gov
80. Spinal hydatid disease with epidural extension and spinal cord compression: A radiology case report.pubmed.ncbi.nlm.nih.gov
81. Ischial osteochondroma as an unusual source of pregnancy-related sciatic pain: a case report.pubmed.ncbi.nlm.nih.gov
82. Imaging guided percutaneous interventions in hepatic dome lesions: Tips and tricks.pubmed.ncbi.nlm.nih.gov
83. Clinical features of Q fever vertebral osteomyelitis: case reports and literature review.pubmed.ncbi.nlm.nih.gov
84. Bilateral subdural empyema diagnosed after middle meningeal artery embolization: illustrative case.pubmed.ncbi.nlm.nih.gov
85. ESR Essentials: acute infections of the head and neck-practice recommendations by the European Society of Head and Neck Radiology.pubmed.ncbi.nlm.nih.gov
86. Retropharyngeal Abscess in an Adult Patient Presenting with Neck Fullness and Dysphagia: A Case Report.pubmed.ncbi.nlm.nih.gov
87. Preoperative Motor and Sensory Dysfunction as Predictors of Permanent Neurological Deficit in Spinal Tuberculosis: A Retrospective Cohort Study.pubmed.ncbi.nlm.nih.gov
88. Clinical Outcomes of Surgical Treatment for Pyogenic Spondylitis According to Surgical Approach.pubmed.ncbi.nlm.nih.gov
89. Tuberculosis revisted: classic imaging findings in childhood.pubmed.ncbi.nlm.nih.gov
90. Recommendations of the International Consensus Meeting (ICM) 2025 on Spinal Infections: Part A Pyogenic Spondylodiscitis.pubmed.ncbi.nlm.nih.gov
91. Recommendations of the International Consensus Meeting (ICM) 2025 on Spinal Infections: Part B Tubercular Spondylodiscitis.pubmed.ncbi.nlm.nih.gov
92. Stability, neurology, infection, and morbidity (SNIM): The quest towards a unified framework for assessment and management of spinal infection:A narrative review and position paper of the EANS spondylodiscitis study group.pubmed.ncbi.nlm.nih.gov
93. Dural perforation and life-threatening central nervous system complications associated with septic arthritis of the lumbar facet joint: illustrative case.pubmed.ncbi.nlm.nih.gov
94. Pictorial review of the post-operative cranium.pubmed.ncbi.nlm.nih.gov
95. Hemorrhagic Lumbar Synovial Cyst: Rare Mimic for Mass Lesion Causing Acute Neurological Deficit.pubmed.ncbi.nlm.nih.gov
96. Lumbar Epidural Cystic Lesion Associated With <i>Finegoldia magna</i> Discitis Presenting as Cauda Equina Syndrome: A Case Report.pubmed.ncbi.nlm.nih.gov
97. Miliary Tuberculosis Diagnosed After Repeated Sputum Smear Examinations Despite Negative Results at a Referral Tuberculosis Center: The Importance of Maintaining Clinical Suspicion.pubmed.ncbi.nlm.nih.gov
98. Purulent infectious myositis of deep core muscles, a MRSA infection in India.pubmed.ncbi.nlm.nih.gov
99. Sacral Osteomyelitis With Abscesses and Fistulae: An Unusual Manifestation of Disseminated Blastomycosis.pubmed.ncbi.nlm.nih.gov
100. Complete radiologic and clinical reversal of lumbar spinal epidural lipomatosis via GLP-1 agonist.pubmed.ncbi.nlm.nih.gov
101. Pregnancy-related aggressive vertebral hemangioma presenting with radiculopathy: illustrative case.pubmed.ncbi.nlm.nih.gov
102. Spinal epidural calcified chondroid mesenchymal neoplasm mimicking epidural abscess: a case report.pubmed.ncbi.nlm.nih.gov
103. Acute Cauda Equina Syndrome Due to Primary Lumbar Spinal Hydatid Cyst: A Rare Case.pubmed.ncbi.nlm.nih.gov
104. Lumbar Ewing's Sarcoma Mimicking a Herniated Disc in a Young Adult: A Case Report.pubmed.ncbi.nlm.nih.gov
105. Clinical presentation, magnetic resonance imaging characteristics, and short-term outcome of deep surgical site infection following thoracolumbar decompressive spinal surgery for intervertebral disc herniation in dogs.pubmed.ncbi.nlm.nih.gov
106. IgG4-Related Disease Strikes the Cervical Spine: First Description of a Rare Cause for C1 Destruction and Tetraparetic Stenosis.pubmed.ncbi.nlm.nih.gov
107. Infectious Spondylodiscitis of Bacterial Causes in Adults: Epidemiology, Pathophysiology, Diagnostic and Treatment Challenges.pubmed.ncbi.nlm.nih.gov
108. Acute paraplegia following epidural analgesia: diagnostic pitfalls in distinguishing pneumorrhachis from surgical mass lesions. Illustrative case.pubmed.ncbi.nlm.nih.gov
109. The Konakondla-Telfeian-Shen (KTS) Pyramid: a safe entry zone for ventral thoracic pathologies.pubmed.ncbi.nlm.nih.gov
110. Lumbar epidural haematoma after acupuncture: a case report and review of the literature.pubmed.ncbi.nlm.nih.gov
111. Lumbar Degenerative Spondylolisthesis and Synovial Facet Cyst With Adjacent Intradural Filum Terminale Lipoma: A Case Report.pubmed.ncbi.nlm.nih.gov
112. <i>Campylobacter jejuni</i>-Associated Lumbar Vertebral Osteomyelitis with Cauda Equina Syndrome in the Absence of Gastrointes Symptoms: A Rare Case Report.pubmed.ncbi.nlm.nih.gov
113. Pathological Vertebral Fractures Misdiagnosed as Osteoporotic Vertebral Fractures: A Case Series of Four Patients and Diagnostic Strategies.pubmed.ncbi.nlm.nih.gov
114. Pregnancy in Women With Klippel-Trenaunay Syndrome Complicated by Uterine Vascular Malformation: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
115. Mixed pyogenic and tuberculous spinal epidural abscesses perforating the dura and extending into the subdural space: A case report and review of the literature.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.