Presentation
Fever of unknown origin. Being treated for a chest infection.
Patient Data
Dense right lower lobe consolidation. Widespread tree-in-bud change throughout the right lung.
Segemental dilatation of the upper oseophagus with a fluid level within.
Bilateral para-spinal soft tissue with extensive vertebral destruction of almost the whole of the thoracic spine.
Bilateral lumbar paraspinal collection and a pre-sacral abscess. Bilateral psoas-iliopsoas collections.
Comment: TB with pulmonary and osseous involvement. Psoas cold abscesses amenable to drainage with ultrasound. Can perform on request. Focal bony destruction at all levels of the lumbar spine and sacrum.
Pathological compression fractures involving T7, T9 and L5.
Multiple enhancing lesions in the spine and pelvis associated with perivertebral enhancing collections. These are at C7 to T12, C7 to T3 and L3 to S1.
No epidural extension.
Bilateral loculated iliopsoas abscesses, larger on the left measuring up to 10.5 x 8.7 cm in maximum axial dimensions.
Grade 1 retrolisthesis of L5 on S1 is secondary to bilateral pars defects. Otherwise the rest of the vertebral alignment is normal.
Right lung consolidation.
Case Discussion
Classic and profound appearances of musculoskeletal and pulmonary tuberculosis. As in this case, advanced disease may present in a relatively occult fashion.
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