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A rare case of radiculopathy in an elderly man
  1. W K Edrees,
  2. B Lee
  1. Level 5, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, UK
  1. Mr Edrees (email:wkedrees{at}hotmail.com)

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An 82 year old man was admitted to a district general hospital with a two week history of pyrexia, low back pain referred down the left leg, and progressive weakness of his left leg. On examination he was pyrexic, 38.5°C, with signs of lower motor neurone lesion extending from L2 to S1 with no other findings. His haemoglobin concentration was 78 g/l, white cell count 7.7 × 109/l, and erythrocyte sedimentation rate 115 mm/hour.

Computed tomography for the LS spine showed no cord compression and identified a lesion at the left psoas muscle. Subsequently, computed tomography of the abdomen was performed (see fig 1). This was followed by aspiration and a core biopsy under computed tomographic guidance. Bacteriology was negative and cytology non-conclusive. The patient was treated empirically with antibiotics and his symptoms gradually settled down.

Figure 1

Computed tomogram of the abdomen.

Seven weeks later, the patient experienced sudden severe abdominal pain and a large mass was apparent in the left side of the abdomen. Computed tomography with enhancement was performed (see fig2).

Figure 2

Computed tomogram with enhancement.

Questions

(1)
Describe the findings in fig 1?
(2)
Describe the findings in fig 2?
(3)
How the patient was managed and what was the diagnosis?

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