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Iatrogenic acute spinal epidural abscess with septic meningitis: MR findings
S Shintani1, H Tanaka, A Irifune
1Department of Neurology, Toride Kyodo General Hospital, Ibaraki, Japan.
Abstract:
A contaminated catheter used in epidural anesthesia in a 71-year-old female produced acute epidural abscess and septic meningitis. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in a culture of the epidural pus. Both T1- and T2-weighted MR images showed low intensity mass lesion compressing the thecal sac behind the vertebral body L3. The low intensity lesion was probably pus with gas component. In these low intensity lesions in MR findings with gas component, MR was superior to myelography because it visualized both the degree of compression to the thecal sac and extension of the lesion in all directions.
Insights
A contaminated epidural catheter led to acute epidural abscess and meningitis caused by MRSA. MRI effectively visualized the abscess, showing its compression of the thecal sac and superiority over myelography for gas-containing lesions.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Epidural anesthesia carries a risk of infectious complications, including epidural abscess and meningitis.
- Contamination of epidural catheters is a potential source of these serious infections.
Observation:
- A 71-year-old female developed acute epidural abscess and septic meningitis following the use of a contaminated epidural catheter.
- Methicillin-resistant Staphylococcus aureus (MRSA) was identified as the causative pathogen in the epidural pus.
Findings:
- Magnetic Resonance (MR) imaging revealed a low-intensity mass lesion at L3, compressing the thecal sac.
- The lesion was characterized as pus with a gas component, indicated by low signal intensity on both T1- and T2-weighted images.
- MR imaging demonstrated superior visualization of thecal sac compression and lesion extension compared to myelography, particularly in cases with gas components.
Implications:
- Early and accurate diagnosis of epidural abscesses is crucial for effective treatment and patient outcomes.
- Advanced imaging techniques like MRI are vital for assessing the extent and impact of spinal infections.
- Understanding the role of MRSA in catheter-related infections highlights the importance of sterile techniques in neuraxial anesthesia.