Tuberculous spondylitis - Pott disease
Recent return from trip to India with back pain. Plain films show destructive process at T12/L1.
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T10 - L1 hetereogeneity of vertebral body bone marrow signal with thin T2 hyperintense mass anterior to the vertebral bodies - note T2 signal in discs is normal.
Diffuse vertebral body enhancement T10 - L1 with enhancement anterior to the vertebral bodies and also leptomeningeal enhancement.
Note: inflammatory enhancement involves contiguous vertebral bodies but not the intervening discs.
Bilateral psoas muscle collections, with peripheral enhancement of consistent with abscesses.
Keys to this case are the history of travel to a TB endemic region, the patient is not particularly unwell (would be septic ++ if pyogenic organism) and the absence of intervertebral disc involvement.
Note: inflammatory enhancement involves contiguous vertebral bodies but not the intervening discs unlike conventional pyogenic endplate osteomyeltis.
Peripheral enhancement of psoas collections consistent with the "cold" abscesses of spinal TB.