Presentation
History back pain with bilateral lower limbs weakness and weight loss for 2 years.
Patient Data
Wall enhancing large multilocular fusiform pre and para-vertebral collections seen extending from D8 to D11 vertebrae and another from inferior endplate of L4 to S3 vertebrae, showing T1 hypointensity, T2/STIR hyperintensity and diffusion restriction on DWI. Vertebral erosions, destruction and marrow edema are seen in these vertebrae.
There are multiple wall enhancing intra-osseous abscesses seen in D10 to S1 vertebrae associated with vertebral destruction. These intra-osseous abscesses are seen to extend into the intervertebral discs with prominent ventral epidural extension at D10/11, L1/2 & L5/S1 disc levels causing canal narrowing.
Bilateral psoas muscles are bulky with large multilocular wall enhancing septate collections extending into the iliacus muscles.
Multiple small wall enhancing lesions are seen in the sacrum, iliac bones and spinous processes of D5, L1 and L2 vertebrae, suggestive of further intra-osseous abscesses.
Complimentary CT was done and it demonstrate multiple vertebral end plates erosions and destruction. Destruction and erosions are also seen in right proximal femur and acetabulum. Small lytic lesions are seen in pelvic bones,spinous processes and left femur.
Case Discussion
Tuberculous spondylitis is an extra-pulmonary tuberculosis commonly seen in developing countries.
This is a case of severe Pott disease with paravertebral abscesses and epidural extension.