Tuberculosis: thoracic manifestations
Back pain. Loss of weight in a young male patient previously well.
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There is gross enlargement and necrosis of retro-esophageal lymph nodes in the mid-posterior mediastinum over a length of 80mm with symmetrical distribution either side of the thoracic vertebrae. Several small necrotic pre vascular and a 13mm aortopulmonary necrotic node is also demonstrated. There is bony involvement with the destruction of the left posterior vertebral body of T8. No obvious extension into the neural canal. The lesion margins appear sclerotic with sclerosis also involving the vertebral body of T7 in the absence of a destructive lesion. There is no apparent disc involvement.
There are multiple broad-based pleural thickenings predominantly involving the posterior wall of both lungs more severe on the left. Atelectasis involving the left lower lobe with associated small left pleural effusion is demonstrated. No evidence of a cavitating lesion or scarring. Ground-glass opacities are seen involving the base of the right upper lobe. Abdominal viscera demonstrated within the limits of this study appear normal. No suspicious soft tissue or bony lesion demonstrated.
Conclusion: Extensive necrotic posterior mediastinal and prevascular lymph nodes with bony destruction involving the left lateral border of the T8 vertebral body. Left lower lobe atelectasis and small effusion with right upper lobe ground glass changes. Findings are in keeping with tuberculosis.
Recommend MRI thoracic spine to confirm suspect spinal canal encroachment.
The prevalence of the disease is around 30 million globally and 1-3% of the 30 million have involvement of bones and joints. Mycobacterium tuberculosis is responsible for almost all the cases of osteoarticular tuberculosis. Although atypical mycobacteria have been reported in lesions of the synovial sheath.
Osteoarticular tuberculosis can occur in the spine, hip, knee, foot, elbow, wrist, hand, shoulder and as diaphyseal foci. It has not been reported to affect mandible and temporomandibular joint. The major method of spread is haematogenous. The most common method of spread to the vertebral body is through Batson's prevertebral venous plexus.
This case was confirmed Mycobacterium tuberculosis infection.