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