Progressive onset of low back pain: unusual imaging findings on CT and MRI

Abstract

A 58-year-old male with a history of chronic hepatitis C and a known chronic multisystem disease who was under long-term corticosteroid treatment with secondary diabetes presented with progressive onset of a diffuse lower back pain without any associated radiation in the lower limbs. No raised temperature or weight loss was noted. On standard biological tests, erythrocyte sedimentation rate (ESR) was not elevated and C-reactive protein was normal (1.6 mg l). White cell blood count was normal. A mild hyperglycaemia was noted. No significant abnormalities were found on plain film images of the thoracic and lumbar spine. Given this rather atypical presentation, a MRI examination of the low thoracic and lumbar spine was performed with sagittal short-tau inversion recovery (STIR) (Figure 1), T1 weighted (Figure 2) and gadolinium-enhanced T1 weighted (Figure 3) sequences. A recent follow-up CT scan of the thorax, abdomen and pelvis was also available and secondarily reformatted in the sagittal plane (Figure 4). What is your diagnosis?