Pott's disease

Case contributed by Dr Mohammad Osama Hussein Yonso

Presentation

The patient complains of cough for 2 years. Weight loss of 8kg in 5 months with low back pain. Went to a private clinic where a chest x-ray showed thoracic spine collection with raised ESR, febrile 38.6C.

Patient Data

Age: 30 years
Gender: Male

Chest X-ray PA

X-ray

Enlarged bilateral paraspinal stripe from the level of the clavicles down to the level of T12 likely representing paraspinal disease.

No sizable pulmonary consolidation or definite cavity.

No pleural effusion or pneumothorax.

Unremarkable heart size.

Dorsal spine AP & Lat

X-ray

Maintained kyphosis of the dorsal spine.

The pedicles are intact.

The intravertebral disc spaces of the T5-6 & T6-7 & T9-10 levels are mildly decreased.

No evidence of spondylolisthesis or lysis was detected.

Bilateral diffuse paraspinal soft tissue density likely abscess.

MRI

Large multiloculated perivertebral abscess collection extending from C7 down to L2 vertebral levels measuring 3 x 7.2 x 30 centimeters in AP, transverse and cranial-caudal dimensions respectively.

It shows high T2, and low T1 signal intensity. A few septations are noted within. It shows multilevel extension into the intercostal spaces.

It also is extending to involve the right psoas muscle as well.

Multilevel abnormal vertebral body bone marrow signal intensity extending throughout the cervical, thoracic and upper lumbar vertebrae along with multilevel intravertebral bodies extension of the abscess most evident at the levels of T3, T4, T6, T7, T10, and T12.

Abnormal intervertebral disc signal intensity at the level of T4-5 and T5-6 along with a small intraspinal epidural extension of the inflammatory process.

No significant vertebral height loss or significant focal kyphotic changes.

Case Discussion

The patient was transferred to the general hospital for further investigations.

MRI was done as mentioned above. 

IMPRESSION:

Large multiloculated, perivertebral abscess collection involving mainly the lower cervical spine and all thoracic regions with minimal intraspinal epidural extension at the level of T5-T6 indenting the spinal cord at this level. No obvious abnormal intramedullary signal intensity change. Features suggestive of extensive TB with Potts disease and large cold abscess collection.

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