Tuberculosis - multisystem

Case contributed by Dr Ian Bickle

Presentation

Fever of unknown origin. Being treated for a chest infection.

Patient Data

Age: 20 years
Gender: Male
CT

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.

MRI

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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Case information

rID: 61162
Published: 30th Jun 2018
Last edited: 30th Jun 2018
Tag: ripas2
Inclusion in quiz mode: Included

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