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Thread: seroma on MRI

  1. #1

    seroma on MRI

    Hi,
    I had an MRI done two months ago and the MRI reports says that there is a subcutaneous fluid collection in the posterior back, possibly a seroma or old hemtorma. Here is a direct quote from the report: "lobulated fluid intensity lesion with hypointense rim of subcutaneous tissues of back at T10 through L1 levels. This measures 2.5 by 2.2 cm in maximum axial diameter, extends 8 cm craciocaudally and may represent a seroma" What does this mean and is it anything serious? Thanks,

  2. #2
    Hi,

    Here is a post that discusses this.
    http://sci.rutgers.edu/forum/archive...p/t-62806.html

    Let me know if you have further questions.

    AAD

  3. #3
    Thank you. My last operation was in october 2006. So does the fluid collection need to be removed or will it be reabsorbed? (They did not use any contrast dye on the MRI) This MRI was done in February. Following the MRI, I had a procedure done at the end of February for an intrathecal pain pump trial where a catheter was inserted and threaded to T9, and they didn't notice anything unusual or encounter any problems when inserting the catheter, so is that a good sign?

  4. #4
    Also, from what I read in the posted link, this type of collection of fluid is not indicative of an infection. Am I right? Will they need to do a spinal tap or something to check?

  5. #5
    A seroma would be just under your skin. It is a pocket filled with serous fluid, which is essentially the liquid (non-cellular) part of your blood. Often they develop from bleeding into the area after surgery. A large one should be able to be felt as a squishy area under the skin.

    If yours is this small, it is likely it will be reabsorbed with time, but if you get redness, swelling or pain over the area, it may need to be drained as it is possible to get infected. I would advise you to call the surgeon who did this surgery and ask them if they want to follow up on the MRI report (I assume they ordered and got the report????).

    (KLD)

  6. #6
    Thank you so much. I felt much better after reading what you wrote. About eight weeks ago, I developed a tiny bump on my back (that was like the size of a large blemish) and it started draining fluid on its own. The fluid didn't smell good and was a brownish color. So my doctor cultured it and it came back infected but he didn't want to do anything about it. So he referred me to a neurosurgeon. My neursurgeon (whom I loved) went into research so I just took whatever doctor was available first. I saw the neurosurgeon and he really scared me. Before he knew about the draining abscess, he said that based on what I wrote about the MRI above, there was a massive infection in the spinal cord and that I would have to have the hardware removed, put on antibiotics for a year and on bedrest, and then have all of the hardware put back in. (I have hardware from T4-T12). I was really confused at this point because the person who ordered the MRI had said that the MRI was fine and that there was nothing wrong. And he said that the infection was really serious and that the infection had just come to the surface with the abscess. But he said that the plastic surgeon would look at the abscess and determine the extent of it. (So basically, I wouldn't be able to get the pain pump for a year). Then it took a few weeks to get an appointment with a plastic surgeon and he looked at it and said that the neurosurgeon would determine what to do about it. But it could just be a simple abscess which would need to be cleaned out and stitched in an OR or it could be an infection in the screw (possibly from the catheter for the pain pump trial) but then the neurosurgeon would just go in and remove the screw. So I left feeling confused and frustrated because they seem to be bouncing me back and forth. It seemed like the neurosurgeon suggested drastic action. Does anyone have any experience with something like this?

  7. #7
    Yes, it could be an infection from what you say. You should have included the additional information in your original post, as the history makes a major difference in my recommendations.

    It could become very serious. I would want to get the neurosurgeon and the plastic surgeon talking to each other (I know, how unrealistic!!). If the infection were to extend to your hardware or into the main CSF it could cause a serious or even fatal infection.

    (KLD)

  8. #8
    Thank you. My big question now is how would this be treated if it were an infection in the hardware. Because I am worried that since it has been six to eight weeks since this started and it is not healing on its own, that if something isn't done it may become more serious. So far the plastic surgeon ordered another MRI. But after I have the MRI it takes a few weeks to get a follow up appointment with the doctor. Both doctors are at the same hospital (Hopkins) and all of the information and notes from the doctors are in the computer system, so I don't really understand why this is so complicated. But I definitely don't want it to get worse, So are there additional tests that I should ask them to write for that they might need so I don't have to go back to the doctor in a few weeks and then find out they want another test? And what are the scenarios on having this treated? If it doesn't extend to the hardware? If it extends to the hardware? And if it is in the CSF? And what are the complications that could occur? I want to be prepared for the doctors since I have gotten so many different opinions. Also, I was going to include all the symptoms, but before I saw some of the doctors I thought that they were two separate issues. Because the neurosurgeon said the seroma was a bad thing based on the MRI (before I even told him about the abscess) and then the orthopedic surgeon had said the MRI was fine. And then 5 different doctors have looked at the abscess and some thought it wasn't anything and then it was the last two that thought it might be an infection. Thanks,

  9. #9
    Infected hardware would be associated as well with osteomyelitis and would require removal of the hardware and many weeks of IV antibiotics. MRI can show osteomyelitis, but you may also need a white cell tagged bone scan to determine the extent, if any, of an infection like this. If you are feeling OK, it may not be extensive, or may not exist at all, but it definitely needs to be investigated, and now.

    CSF = cerebral spinal fluid. If you get infection here, you can have meningitis which can be life threatening. You would be very ill with a high fever.

    Call the physicians who said it was infected TOMORROW and insist that they see you or talk to the original surgeon ASAP, not in weeks.

    (KLD)

  10. #10
    Thank you so much for your advice. I can't believe that it took that long to get an MRI which is all he said that he needed. The MRI dept initially said they couldn't schedule me until June 18th or something like that so my doctor called and it even took them a week to get me on the schedule. I have been calling his office and his nurse practitioner said that he would look over the results and give me a call. Despite my calls, I am still waiting so I picked up a copy of the MRI report and I was wondering if you could offer some help.

    Here is what the new one says, I'm going to skip the parts where it talks about the fusion.
    "The alighment of hte thoracic vertebral boides appears anatomic with no marrow signal abnoramlity seen, as best can be determined given the artifact from hardware. Evaluation of spinal cord is limited in region of hardwar, but otherwise appears unremarkable in signal and morphology. There is a fluid collection in the posterior spinal soft tissues at the T7 level which measures 2.0cm craniocaudal by 1.3cmAP by 1.6cm transverse. A previously noted fluid collected in the posterior spinal soft tissues of the lower thoracic and upper lumbar region has improved and is no longer well visualized."

    So I have a few questions. Since it mentiones spinal soft tissues, does that mean that the infection most likely does not extend to the hardware? And also the abcess is closer to T9 than T7 so is it possible that the two are not related? Does the abscess usually appear at the level where the fluid is or is it possible that it appears somewhere else? And since the last collection of fluid resolved itself, it is possible that this fluid collection will do the same providing that someone treats the actual abscess on the surface? It is still draining a good amount of fluid that is foul smelling but has not increased in size. It was cultured a while ago and grew out some bacteria, but I was never placed on an antibiotic for it. I would truly appreciate your help again. Thanks,

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