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Tuberculous spondylitis - Pott disease

Case contributed by Dr Chris O'Donnell

Presentation

Recent return from trip to India with back pain. Plain films show destructive process at T12/L1.

Patient Data

Age: 35 years
Gender: Male

T10 - L1 heterogeneity 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 a peripheral enhancement of consistent with abscesses. 

Case Discussion

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 osteomyelitis. 

Peripheral enhancement of psoas collections consistent with the "cold" abscesses of spinal TB. 

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Case information

rID: 16502
Published: 23rd Jan 2012
Last edited: 26th Sep 2019
Inclusion in quiz mode: Included

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