• There is evidence of active osteomyelitis at the T5 and T6 levels manifest by bone oedema and a large lobular pre-vertebral abscess extending proximally to the C6-C7 disc level, but no evidence of epidural collection or cord compression.
• There is prominent generalised upper thoracic kyphosis between the T1 and T7 levels with vertebra plana at T5. Extensive abnormal oedema-like marrow signal involves the T6 and T7 levels, and to a lesser extent C6 and several of the lower cervical vertebra. There are multiple lobular pre-vertebral collection with multiple gas-fluid levels tracking into the intervertebral foramina bilaterally and around the paravertebral spaces particular on the left side, then into the posterior soft tissues to the skin sinus. No appreciable epidural collection and although the cord is kinked over the kyphus, there is no evidence of cord compression. No intrinsic cord lesion is identified. No marrow abnormality is demonstrated above C5 or below T8 and therefore there is no evidence of non-contiguous vertebral osteomyelitis. Minor disc degeneration is noted at L5-S1, and an elongated lobular cystic lesion is noted anterior to the thoracolumbar junction may represent a dilated thoracic duct.
• Conclusion: The features would be consistent with marked multilevel cervico-thoracic osteomyelitis with extensive pre-and para-vertebral abscess formation tracking to a sinus in the posterior midline at the level of the apex of the kyphus.