Pott disease

Case contributed by Dr Ahmed Abd Rabou

Presentation

Patient with neck pain and right hand numbness.

Patient Data

Age: 25 years
Gender: Male
X-ray

Cervical X ray shows subtle widening of the prevertebral soft tissue shadow anterior to C5 and C6 vertebrae.

Unfortunately had her cervical x-ray interpreted as normal. After 1 month she was admitted with cachexia and fever and had further imaging. 

MRI

One month later

There was subtotal destruction of C2 and C6 vertebral bodies with less affection of C5 and extensive marrow edema and enhancement involving the cervical vertebrae down to D2. Nevertheless, there was two large paravertebral abscesses one opposite the right side of C2 with small epidural component and a larger multiloculated pre and para vertebral abscess more to the right side with epidural extension through right C6-C7 neural foramen and moreover there is an inferior extension reaching the posterior mediastinum. The two abscesses appeared connected. There was gibbus deformity at C6-C7 level.

Case Discussion

The case represents classic findings of Pott disease (TB spondylodiscitis) and paravertebral abscess as evident by involvement of the vertebral body more than the disc, skip lesions, gibbus defomity and paravertebral abscess. Unfortunately the cervical radiograph was misreported as normal and the patient came back after complications were occurred.

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Case information

rID: 34917
Case created: 14th Mar 2015
Last edited: 20th Aug 2017
System: Spine
Inclusion in quiz mode: Included

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