A case of T1/T2 pyogenic spondylitis associated with mediastinal abscess

Abstract

A 65-year-old woman complaining of back pain and low-grade fever was admitted to a local hospital with mediastinal abscess. Because conservative treatment was ineffective, she was referred to our hospital 10 days after onset. CT scan revealed a multilocular abscess with ring enhancement on both sides of T1/T2. A T2-weighted MRI image showed a high-intensity area in the T1/T2 vertebral body and intervertebral disc, suggesting spondylitis complicating mediastinal abscess.
Considering there was neither a neurological symptom nor bone destruction, abscess drainage of the superior mediastinum was performed, and spondylitis was planned to undergo conservative medical treatment. With the combination of cervical collar incision and thoracoscopic surgery, effective drainage was conducted. Streptococcus intermedius was detected in the abscess cavity. She was discharged 37 days after surgery, and followed a favorable course for a year.
As one of the causes of mediastinal abscess, pyogenic spondylitis should be considered. MRI is useful for the diagnosis. Surgical indications were reported in such cases as neurological symptoms and abscess formation.