Presentation
Subacute bilateral lower limbs weakness and numbness.
Patient Data
On the STIR sequence, abnormal bone marrow hyperintense signal at the C5, T1, and T2 vertebral bodies. Abnormal vertebral body destruction/erosion at the superior half of the T2 vertebral body, whereas the adjacent intervertebral disc is relatively preserved. Peripheral rim enhancing collection at T1/T2 intervertebral level, extending anteriorly as subligamentous collection underneath the anterior longitudinal ligament, laterally as a bilateral paraspinal collection, posteriorly as epidural collection, and occupying the T2 intervertebral foramina.
The epidural collection extends from the T1 vertebral level to the lower border of the T3 vertebral level, which causes significant severe spinal canal stenosis. The epidural collection showed smooth thin peripheral rim enhancement.
The thoracic spinal cord shows intraspinal high signal intensity on T2W and STIR sequence in keeping with spinal cord myelopathy from T1 to T5 level.
High signal intensity at C5/C6 intervertebral disc with the abnormal high signal intensity of C5 is suspicious of vertebral disc involvement. Hypertrophy of the ligamentum flavum with mild spinal canal stenosis at the C5/C6 level.
No significant contrast enhancement of the intervertebral discs.
Incidental finding of spiculated lung cavity/nodule at the posterior segment of the right upper lobe.
Case Discussion
This case showed typical MR imaging features suggesting tuberculous spondylitis rather than pyogenic spondylitis.
involvement of multiple vertebral bodies
paraspinal abscesses with well-defined margin
intraspinal/epidural abscess
involvement of the thoracic spine with vertebral body destruction
relatively little involvement of intervertebral discs
The patient was smear-positive for tuberculosis (from sputum culture) and treated with anti-tuberculous medication.
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