Spinal tuberculosis

Case contributed by Dr Henry Knipe

Presentation

Four weeks of bilateral posterior pleuritic chest pain.

Patient Data

Age: 30 years
Gender: Male
X-ray

Lungs and pleural spaces are clear. Cardiomediastinal contour is normal. Anterior wedging of T10 vertebral body with irregularity of the inferior endplate and left paraspinal opacity. Absent right L1 pedicle (winking owl sign). 

CT

Lungs and pleural spaces are clear. No mediastinal lymphadenopathy. Upper abdomen is unremarkable. 

Crush fracture at T10 with vertebral body lytic lesion. Destructive lytic lesion at the right L1 vertebral body involving the right pedicle. 

Right seventh rib with soft tissue mass.

The patient underwent image guided aspiration of the paraspinal soft tissue:

DETECTED NUCLEIC ACID TESTING (ON SPECIMEN) DNA Amplification Assay for M.tuberculosis Complex(PCR): See comment below M. tuberculosis Complex PCR: DETECTED

POSITIVE MYCOBACTERIAL CULTURE 1.Acid Fast Bacilli ISOLATED

Case Discussion

Spinal tuberculosis (Pott disease) is not an uncommon manifestation. Presentation and imaging can be specific, and the imaging differential diagnosis for this case includes other lytic bone lesions such as metastases and lymphoma.

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Case information

rID: 48800
Case created: 25th Oct 2016
Last edited: 20th Apr 2017
Inclusion in quiz mode: Included

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