Pott disease

Case contributed by Dr Amr Farouk

Presentation

Fever, weight loss and severe back pain.

Patient Data

Age: 30 years
Gender: Female
CT

An ill defined heterogeneously enhancing right paraspinal  lesion is seen encroaching on the apical and medial basal segments of the right lower lung lobe, measuring about 5.5 x 4.7 x 7.7 cm along its AP, TS and CC dimensions respectively, with surrounding area of consolidation, showing air bronchogram within. The mentioned lesion is seen reaching to the right lower lobe segmental bronchi as well as the related vessels, and abutting the right main bronchus and pulmonary vessels as well as the azygos vein. Few surrounding nodular densities are seen involving the right lower lobe, as well as the posterior segment of the right upper lobe some of them are pleural based, largest measures about 2.2 cm. The described right lower lobe paravertebral lesion is seen inseparable from multiple enlarged right hilar and subcarinal mediastinal lymph nodes with other discrete retrocaval lymph node is seen measuring about 1.3 x 1 cm. mild left basal pleural thickening / effusion is noted with few related basal pulmonary atelectatic bands.

A large destructive left parspinal soft tissue lesion is seen centered on and destructing the posterior portion of 5th and 6th ribs as well as the adjoining parts of the related vertebral bodies, measuring about 6x5.8x7.2 cm along its TS, AP and CC dimensions respectively, seen having an intra-thoracic extra-pulmonary component attaining a left paravertebral / posterior mediastinal location, it is seen extending through the left D4-5 down to D6-7 neural foramina having an intraspinal extradural component compressing the dorsal spinal cord, it is seen also infiltrating the left paraspinal muscles at that level with associated small subcutaneous cystic component.

Other similar yet smaller destructive osseous lesions are seen involving the heads of left 10th and 12th ribs with similar associated neural compromise.

Minimal pericardial effusion is noted.

Left iliac laterally located subcutaneous cystic lesion is seen.

MRI

A large destructive complex cystic and solid left paraspinal soft tissue lesion is seen centered on and destructing the posterior portion of the left 5th and 6th ribs as well as the adjoining parts of the related vertebral bodies, measuring about 6 x 7 cm along its axial dimensions respectively, showing cystic components of high T1 signal (high protein content), showing heterogenous intense post contrast enhancement. The mentioned left paravertebral disease process is seen having an intra-thoracic extra-pulmonary component attaining a left paravertebral / posterior mediastinal location. It is seen extending through the left D4-5 down to D6-7 neural foramina having an intraspinal extradural component compressing the dorsal spinal cord, it is seen also infiltrating the left paraspinal muscles at that level with associated small subcutaneous cystic component. abnormal bone marrow signal pattern of the related D4 down to D6 vertebral bodies (edema pattern).

other similar yet smaller destructive osseous lesions are seen involving the heads of left 10th and 12th ribs with similar associated neural compromise, with associated similar abnormal signal of the related vertebral bodies.

An ill defined heterogeneously enhancing right paraspinal lesion is seen encroaching on the apical and medial basal segments of the right lower lung lobe, measuring about 5.5x4.5x7.5 cm along its AP, TS and CC dimensions respectively, with surrounding area of consolidation.

Case Discussion

The described features are suggestive of multilevel paravertebral inflammatory process (spondylodiscitis / Pott disease) with associated perivertebral and intraspinal extradural soft tissue phlegmon / abscesses.

Fine needle aspiration from the left iliac cystic lesion showed a chronic abscess and core biopsy from the left paraspinal mass showed granulomatous inflammation (TB) with superadded suppuration.

PlayAdd to Share

Case information

rID: 44388
Case created: 19th Apr 2016
Last edited: 23rd Apr 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.