St Peter's Hospital, General Surgery Department, Guildford St, Lyne, Chertsey, KT16 0PZ, UK.
Spinal Cord Ser Cases. 2023 Jul 31;9(1):38. doi: 10.1038/s41394-023-00598-y.
Paraspinal abscesses are rare infections affecting the paraspinal muscles and soft tissues. An evolving abscess may pose a threat to the spinal cord via the compressive effect which can manifest as impaired motor or sensory function at the corresponding vertebral level. Paraspinal abscess is often a late diagnosis due to non-specific symptoms at presentation. This results in high morbidity and mortality.
We describe the case of a 59-year-old female with a paraspinal abscess presenting with epigastric pain who was initially worked up for a suspected intra-abdominal pathology, however computerised tomography of the chest, abdomen, and pelvis (CTCAP) revealed no abnormality. Later, rising inflammatory markers, accompanied by worsening cervicalgia, prompted a CT of the head, neck and thorax which revealed a soft tissue abscess compressing the thecal sac at cervical levels 1 to 3 (C1-3). This was successfully managed with radiologically guided drainage and long-term intravenous antibiotics. Our patient made a full recovery and a repeat MRI demonstrated resolution of the abscess.
We demonstrate that spinal abscess can present with a misleading combination of symptoms and highlight the importance of considering rarer differentials in the face of an evolving clinical picture. Our case also demonstrates that once the correct diagnosis is reached, patients can make an excellent recovery from uncomplicated spinal abscesses.
脊柱旁脓肿是一种罕见的感染，影响脊柱旁肌肉和软组织。不断发展的脓肿可能通过压迫作用对脊髓造成威胁，表现为相应节段的运动或感觉功能受损。由于脊柱旁脓肿在发病时症状不典型，往往诊断较晚。这导致发病率和死亡率都很高。
我们描述了一例 59 岁女性脊柱旁脓肿的病例，其表现为上腹痛，最初被怀疑为腹腔内病变，但胸部、腹部和骨盆的计算机断层扫描（CTCAP）没有发现异常。后来，炎症标志物升高，同时颈椎痛加重，促使进行头部、颈部和胸部的 CT 检查，发现颈 1 至 3 节段（C1-3）的硬脊膜囊受压的软组织脓肿。经放射引导引流和长期静脉内抗生素治疗后，脓肿得到成功处理。我们的患者完全康复，重复 MRI 显示脓肿已消退。
我们证明了脊柱旁脓肿可能会出现误导性的症状组合，并强调在面对不断变化的临床情况时，要考虑到更罕见的鉴别诊断。我们的病例还表明，一旦确诊，患者可以从简单的脊柱旁脓肿中完全康复。
