Lower back pain in a 50-year-old diabetic patient- an early CT sign not to be missed

Abstract

The incidence of infectious spondylitis has recently increased as more patients are prone to infection while diagnostic accuracy has also improved. Emphysematous osteomyelitis of the spine is a rare clinical condition with high mortality rates caused by gas-forming organisms. Magnetic Resonance Imaging (MRI) is regarded as the gold standard method in the diagnosis of spinal infections as it can also aid in the differential diagnosis between in infection and other clinical conditions. However, Computed Tomography (CT) can also aid in the diagnosis as it is usually the first imaging examination of patients presenting with lower back pain especially in the emergency department.

A 50-year-old male patient presented to our Emergency Department complaining of severe lower back pain during the last seven days. His past medical history included hypertensions and diabetes. Investigation in the emergency department included a CT of the lumbar spine which revealed intraosseous air in the L4 vertebral body and in the right psoas muscle. Emphysematous spondylodiscitis was suspected as a possible diagnosis and the patient underwent an MRI the following day which confirmed the diagnosis.

This case report highlights the importance of recognizing the early CT sign of intraosseous and paraspinal gas in order to facilitate early and accurate diagnosis of this life-threatening condition.