Presentation
Backache with paraplegia.
Patient Data
Multilobulated bone lesions that show low T1 and high T2/STIR signal intensity, involving T6, T7, and T8, with collapse of T6, and ipsilateral extension to the posterior aspect of the 7th rib, thoracic cavity, and adjacent muscles.
Extensive involvement of the posterior elements is seen, extending into ventral and dorsal epidural space and compressing the spinal cord, which is showing expansion and high T2/STIR signal intensity, consistent with spinal canal stenosis and compressive myelopathy.
The differential diagnosis in this age should include tuberculous spondylodiscitis, telangiectatic osteosarcoma, and aneurysmal bone cysts (the last two have fluid-fluid levels which are not shown in this case).
Case Discussion
Emergent surgery was done due to spinal cord compression. Pathologically proven hydatid cysts.
Spinal hydatid disease is uncommon and most commonly affects the thoracic spine. Spinal cord compression is the most common manifestation of spinal hydatid disease. Despite treatment, the condition commonly recurs with progressive spinal column damage and neurological decline.
Acknowledgment: Dr. Ali Hekmat (consultant neurosurgeon).
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