Pott disease

Case contributed by Dr Amr Farouk

Presentation

Recent onset lower limb weakness.

Patient Data

Age: 55 years
Gender: Male
Nuclear medicine

Bone Scan

Increased tracer uptake of T8, T9, and T10 vertebral bodies.

CT

Right upper lobe posterior lobe pulmonary air-filled cavitary lesion is seen with irregular outer mural surface and smooth inner surface. An adjacent similar cavity is seen anteriorly. No intra-cavitary air fluid levels or intracavitary soft tissue. Surrounding mainly upper lobe and, to a lesser extent, middle lobe scarring, fibrosis, alveolar consolidations and tree-in-bud pattern, as well as centrilobular nodules, are seen. Left upper lobe apico-posterior segment alveolar consolidations and tree-in-bud pattern are seen. Enlarged retrocaval, pre carinal & right hilar lymph nodes ar seen.

T8 and T9 vertebral bodies reduced anterior height with diffuse sclerotic texture and transversely oriented cleft filled with hyperdense content. It is seen associated extraosseous soft tissue is seen, having pre, para and intra-spinal components showing heterogeneous enhancement with calcific foci within. The intraspinal component is seen compressing the thecal sac extending opposite the length of T8 and T9 vertebral bodies and T9/10 disc space.

MRI

Marked reduction in the anterior heights of T8 and T9 vertebral bodies showing abnormal outline, irregular opposing end plates and near total obliteration of the intervening disc space. They show diffusely low T1 and bright T2 and STIR signal with contrast uptake in the post-contrast series. They are also surrounded by an irregular para-spinal and intraspinal soft tissue component that exhibits heterogeneous low T1 and bright T2 signal intensity with heterogeneous contrast uptake in the post-contrast series where it also shows areas of ring enhancement. The intraspinal component is seen effacing the ventral subarachnoid space and indenting the dorsal cord at T8-9 level. The opposing spinal cord shows bright T2 and STIR signal within.

Case Discussion

Right upper lobe pulmonary cavitary lesions with surrounding pulmonary parenchymal scarring, fibrosis and alveolar consolidations with lower dorsal spondylodiscitis and associated soft tissue component causing compressive myelopathy.

Fine needle aspiration from the thoracic vertebral lesion showed granulomatous inflammation (TB).

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Case information

rID: 54533
Case created: 13th Jul 2017
Last edited: 27th Jul 2017
Inclusion in quiz mode: Included

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