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Spinal epidural abscess — ABEM Board MCQ

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HardNeurological emergenciesSpinal epidural abscessABEM Board

A 46-year-old man who injects drugs arrives with back pain and fever. Triage acuity is ESI 2; T 102.1 F, HR 118/min. He has midline thoracic tenderness, urinary retention, and new bilateral leg weakness. ESR is markedly elevated. Which of the following is the most appropriate imaging study?

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Correct answer: A — MRI of the spine with contrast

Fever, focal spine pain, and neurologic deficits require emergent MRI to evaluate for spinal epidural abscess.

Reference: IDSA vertebral osteomyelitis guidance; emergency spine references