Disseminated tuberculosis with spondylitis (Pott disease) and massive iliopsoas abscesses

Case contributed by Dr Michael P Hartung


Abdominal discomfort.

Patient Data

Age: 30 years
Gender: Male

Left anterior and right posterior pleural thickening, small right effusion. Miliary micronodules bilaterally.

Small subdiaphragmatic and inferior right hepatic lobe perihepatic collections. Mild striated left nephrogram. 

Massive bilateral iliopsoas abscesses with small components extending into the paraspinal muscles. Right extends into upper thigh. 

Small anterior longitudinal subligamentous abscess in the lower thoracic/upper lumbar spine. 

Several low-attenuation mesenteric lymph nodes that are challenging to distinguish from small bowel on axial, but more readily distinguished on coronal. 

Erosive changes around the periphery of many vertebral body levels. 

Case Discussion

Advanced, late stage presentation of disseminated tuberculosis with miliary pulmonary involvement, spondylitis characterized by subligamenous abscesses, vertebral body erosions, massive iliopsoas abscesses, and mesenteric adenopathy. The subligamenous spread of infection with anterior vertebral body irregularities and decompression into the surrounding musculature is typical of advanced tuberculous spondyloarthropathy, although abscesses of this size are quite unusual. Pleural thickening/effusion, left pyelonephritis, and small extrahepatic collections are other manifestations. 

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Case information

rID: 83450
Published: 24th Oct 2020
Last edited: 25th Oct 2020
Inclusion in quiz mode: Included
Institution: Diospi-Suyana Hospital