Tuberculous spondylitis with large prevertebral abscess

Case contributed by Andrew Dixon

Presentation

Presented to the Emergency Department with Horner syndrome. On examination he was found to have large swelling in the neck.

Patient Data

Age: 30 years
Gender: Male

There is widening of the superior mediastinum with trachea displaced anteriorly on the lateral image. Prevertebral soft-tissues are expanded - greater than one vertebral body thickness in the lower cervical spine.

CT and MR imaging shows large septated prevertebral / paravertebral cervical and upper thoracic low density collection with enhancing wall. Destruction of multiple upper thoracic vertebrae is seen along with an epidural collection.  

MR imaging shows large septated prevertebral / paravertebral cervical and upper thoracic low intensity collection with enhancing wall. Destruction and abnormal enhancement of multiple upper thoracic vertebrae is seen along with an epidural phlegmon. 

Case Discussion

CXR shows widened superior mediastinum with the trachea displaced anteriorly on the lateral image. Prevertebral soft-tissues are expanded: greater than one vertebral body thickness in the lower cervical spine.

CT and MR imaging shows a large septated prevertebral / paravertebral cervical and upper thoracic low density collection with enhancing wall. Destruction of multiple upper thoracic vertebrae is seen along with an epidural collection.  

Features are consistent with tuberculous spondylitis (Pott disease) complicated by a large prevertebral / paravertebral abscess. Acid-fast-bacilli were subsequently confirmed. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.