Spinal Epidural Abscess and Medical Malpractice: The Role of Diagnostic Imaging in Legal Cases

Spinal epidural abscess (SEA) is a rare but serious infection that can lead to permanent neurological deficits. Despite guidelines recommending MRI for diagnosis, SEA is frequently missed in initial assessments due to the use of CT. This article examines medical malpractice lawsuits involving missed SEA diagnoses, focusing on the legal implications of imaging decisions and diagnostic delays.

A search was conducted in the Westlaw legal database to identify malpractice cases related to missed SEA diagnoses in which CT imaging was performed. Boolean search terms included "misdiagnosis," "missed," "epidural abscess," and "CT scan." 27 cases were identified, of which six were determined to be relevant following manual screening. Each case was analyzed for medical and legal considerations, including diagnostic delays, imaging limitations, standard-of-care breaches, and litigation outcomes.

In all analyzed cases, diagnoses were delayed due to use of CT rather than MRI. Courts were more likely to rule in favor of plaintiffs when delays resulted in paraplegia or quadriplegia, with significantly higher monetary awards for severe neurological outcomes. Some cases demonstrate nuanced legal arguments, such as whether SEA should be detected during evaluation for other conditions.

Missed SEA diagnoses often stem from inappropriate use of CT. Lowering the threshold for MRI in patients with back pain could improve diagnostic accuracy but may increase healthcare costs and imaging burden. Radiologists should be aware of CT's limitations and explicitly document them. Further guidelines are needed to standardize the appropriate use of imaging in back pain evaluations.