Presentation
Loss of weight, fever and mid thoracic back pain. No neurology.
Patient Data
An abnormal contour is present bilaterally along the paraspinal stripe. On lateral projection this matches a region of increased density.
End plate irregularity and a low density paraspinal collection are present.
Lung CT demonstrates areas of tree-in-bud opacities consistent with endobronchial spread.
Multiplanar pre and post contrast scans were obtained through the thoracic region.
Extensive signal abnormality and abnormal enhancement involve the T6 and T7 vertebral bodies and the intervening disc consistent with discitis osteomyelitis and there is involvement of the left-sided pedicles at T6 and T7. Large multiloculated paravertebral collections are present bilaterally. On the left these extend posterior to and are contiguous with the descending thoracic aorta. Anteriorly there is subligamentous spread extending cephalad to the T4 level and caudally to the level of the T8/9 intervertebral disc.
Subtle signal abnormality and abnormal enhancement involve the anterior aspect of the T5 vertebral body suggesting early osteomyelitis at this site. No other vertebral involvement is identified in the thoracic region. There is minimal epidural inflammatory tissue and no epidural abscess is identified. The thoracic vertebral canal is capacious and the thoracic cord is of normal caliber and signal. There is no significant exit foraminal encroachment.
Features are consistent with discitis osteomyelitis. Given the patient's demographic and the large size of the paravertebral collections, tuberculous spondylitis (Pott's disease) is the favored diagnosis.
Case Discussion
This case demonstrates typical appearances of tuberculous discitis/osteomyelitis.
The diagnosis was confirmed on sputum and paraspinal aspirate.
- AFB on sputum.
- PCR positive aspirate from the paraspinal collection.