Pott disease

Case contributed by Hani M. Al Salam
Diagnosis certain

Presentation

Vague backache.

Patient Data

Age: 60 years
Gender: Female

Thoracic spine

x-ray
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Thoracic spine radiographs showed a destructive process involving T11 associated with kyphosis of the spine which was confirmed on thoracic spine CT.

Thoracic spine

ct
This study is a stack
Axial bone
window
This study is a stack
Coronal
bone window
This study is a stack
Sagittal
bone window
This study is a stack
Axial
non-contrast
This study is a stack
Coronal
non-contrast
This study is a stack
Sagittal
non-contrast
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Destructive processes involving T11 and T12 with associated kyphosis of the thoracic spine.

Thoracic spine

mri
This study is a stack
Sagittal
T2
This study is a stack
Sagittal
T1
This study is a stack
Sagittal T1
C+ fat sat
This study is a stack
Sagittal
T2
Sagittal T1
C+ fat sat
This study is a stack
Coronal T1
C+ fat sat
This study is a stack
Axial T1
C+ fat sat
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Info

Thoracic spine MRI demonstrates a kyphotic deformity involving the thoracolumbar region secondary to the destructive process involving the T11-12 junction. The process appears to involve the inferior aspect of the T11 and superior aspect of T12 vertebra with loss of height and evidence of paraspinal and spinal canal extension.
 
Post gadolinium demonstrates enhancement of the residual T11-12 vertebra adjacent to the disc which does not show any dominant enhancement. The anterior paraspinal extension of the process shows a cranial extension with peripheral enhancement raises the possibility of a localized abscess formation.  At this level, the spinal canal component effacing the anterior subarachnoid space and causes significant spinal cord compression with focal increased T2 signal indicating cord edema. 

Case Discussion

Thoracic spine radiographs showed a destructive process involving T11 associated with kyphosis of the spine which was confirmed on thoracic spine CT.

Thoracic spine MRI demonstrates a kyphotic deformity involving the thoracolumbar region secondary to the destructive process involving the T11-12 junction. The process appears to involve the inferior aspect of the T11 and superior aspect of T12 vertebra with loss of height and evidence of paraspinal and spinal canal extension.
 
Post gadolinium demonstrates enhancement of the residual T11-12 vertebra adjacent to the disc which does not show any dominant enhancement. The anterior paraspinal extension of the process shows a cranial extension with peripheral enhancement raises the possibility of a localized abscess formation.  At this level, the spinal canal component effacing the anterior subarachnoid space and causes significant spinal cord compression with focal increased T2 signal indicating cord edema. 

Pathologically proven Mycobacterium tuberculosis infection of the thoracic spine (aka Pott disease)

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