Presentation
Pain
Patient Data
There is collapse of the T10 vertebral body associated with angular kyphosis, and retropulsion of the posterior aspect of the vertebral body that is posteriorly displacing the cord with mild cord hyperintensity. At this level, there is pre- and paravertebral soft tissue phlegmon, with areas of increased T2 signal suggestive of abscess formation. The intervertebral discs are spared. There is subligamentous spread up to the level of the T9 superior endplate and down to the level of the T11 superior endplate. There is also subligamentous spread along the PLL up to the T9 inferior endplate.
Additional areas of osteomyelitis, again sparing the discs, at T6, T7 and L1.
Features are those of tuberculosis.
Case Discussion
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.