Presentation
Cough, dyspnea, chest pain.
Patient Data
There are multiple small nodules scattered throughout both lungs. They are uniform in size and distribute diffusely on subpleural, peribronchovascular, and centrilobular consistent with random distribution.
The centrilobular nodules with a linear branching pattern are suggestive of the tree-in-bub sign.
Some of the mass-like consolidations result from the coalescence of smaller nodules suggestive of the galaxy sign.
The cavity with the irregular thick wall is also seen on the left upper lobe.
CT bone window demonstrates lytic destruction of the thoracic vertebral body (T10, T11, T12) with relative preservation of the disc spaces.
Three thoracic vertebral bodies(T10, T11, T12) show hypointense on T1, heterogenous hyperintense on T2, STIR, enhancement post-administration of contrast.
Axial fat-suppressed contrast-enhanced T1-weighted image shows ill-defined paraspinal abnormal enhancement and the abscess with smooth peripheral enhancement on the epidural cavity, vertebral intraosseous.
The T10-T11, T11-T12 discs show high signal on STIR but relatively preserved disk-space height.
There is cord compression corresponding with the T11 vertebra.
Case Discussion
The chest CT shows multiple nodules with random distribution, the tree-in-bub sign, galaxy sign and pulmonary cavity suggestive of miliary tuberculosis.
The lesion in vertebrae is consistent spondylodiscitis involving more than two thoracic vertebral bodies with epidural, intraosseous abscess, and relatively preserved disk-space height, which are favors findings indicating tuberculous spondylitis.
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