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Tuberculous spondylitis with large prevertebral abscess

Case contributed by: Dr Andrew Dixon

Presentation:

29 year old male migrant to Australia from India who presented to Emergency with Horner's Syndrome. On examination he was found to have large swelling in the neck.

From the case: Tuberculous spondylitis with large prevertebral abscess
Modality: X-ray

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  • <p>TB Spondylitis with Prevertebral Abscess</p> Patient with tuberculous spondylitis (Pott's disease) complicated by a large prevertebral / paravertebral abscess. Chest radiographs show widened superior mediastinum with trachea displaced anteriorly on the lateral image. Prevertebral soft-tissues are expanded: greater than one vertebral body thickness in the lower cervical spine.

TB Spondylitis with Prevertebral Abscess

Patient with tuberculous spondylitis (Pott's disease) complicated by a large prevertebral / paravertebral abscess. Chest radiographs show widened superior mediastinum with trachea displaced anteriorly on the lateral image. Prevertebral soft-tissues are expanded: greater than one vertebral body thickness in the lower cervical spine.
From the case: Tuberculous spondylitis with large prevertebral abscess
Modality: CT

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  • <p>TB Spondylitis with Prevertebral Abscess</p> Patient with tuberculous spondylitis (Pott's disease) complicated by large prevertebral / paravertebral abscess. CT and MR imaging shows large septated prevertebral / paravertebral cervical and upper thoracic low density collection with enhancing wall. Destruction of multiple upper thoracic vertebrae is seen along with an epidural collection.

TB Spondylitis with Prevertebral Abscess

Patient with tuberculous spondylitis (Pott's disease) complicated by large prevertebral / paravertebral abscess. CT and MR imaging shows large septated prevertebral / paravertebral cervical and upper thoracic low density collection with enhancing wall. Destruction of multiple upper thoracic vertebrae is seen along with an epidural collection.
From the case: Tuberculous spondylitis with large prevertebral abscess
Modality: MRI
  • <p>TB Spondylitis with Prevertebral Abscess T1 FS Post Gad</p> Patient with tuberculous spondylitis (Pott's disease) complicated by large prevertebral / paravertebral abscess. CT and MR imaging shows large septated prevertebral / paravertebral cervical and upper thoracic low density collection with enhancing wall. Destruction of multiple upper thoracic vertebrae is seen along with an epidural collection.

TB Spondylitis with Prevertebral Abscess T1 FS Post Gad

Patient with tuberculous spondylitis (Pott's disease) complicated by large prevertebral / paravertebral abscess. CT and MR imaging shows large septated prevertebral / paravertebral cervical and upper thoracic low density collection with enhancing wall. Destruction of multiple upper thoracic vertebrae is seen along with an epidural collection.

Case Discussion:

CXR shows widened superior mediastinum with the trachea displaced anteriorly on the lateral image. Prevertebral soft-tissues are expanded: greater than one vertebral body thickness in the lower cervical spine.

CT and MR imaging shows a large septated prevertebral / paravertebral cervical and upper thoracic low density collection with enhancing wall. Destruction of multiple upper thoracic vertebrae is seen along with an epidural collection.  

Features are consistent with Tuberculous Spondylitis (Pott's Disease) complicated by a large prevertebral / paravertebral abscess.  Acid-fast-bacilli  were subsequently confirmed. 

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