Tuberculous spondylodiscitis

Case contributed by Mostafa Mohamed
Diagnosis certain

Presentation

Back pain.

Patient Data

Age: 20 years
Gender: Male
mri

A multilevel inflammatory process is seen implicating several thoracic, lumbar and sacral vertebrae with involvement of some of the intervening discs being most evident at T4/5, T7 down to T10/11, T12/L1, L3/4, L5, S1, and S2 levels.

Evidence of vertebral structural collapse of D8 and D10 vertebral bodies. Less manifest sagging of D7 and L1 superior vertebral end plates is noted.

The affected vertebrae and intervening discs elicit patchy predominantly low signal at T1 and high signal at T2 & STIR WI with variable degrees of erosive changes of the vertebral end plates. These changes are seen extending to some of the related posterior neural elements. Few of the intervening vertebrae display rather preserved marrow signal.

Associated multilevel ill-defined epidural, pre-vertebral, and paravertebral soft tissue/cystic components which elicit low T1 high T2/STIR signal. It appears inseparable from the left psoas at L4/5 level.

The epidural components appear most evident opposite left T8 and right T10 vertebral levels. They are seen effacing the epidural fat, indenting the cord, and encroaching upon the left T8/9 and right T10/11 neural exit foramina.

A large posterior paravertebral component is seen arising at T7/8 level showing intramuscular extension along the related left posterior paraspinal muscles and ascending superior.

Normal size and signal intensity of the dorsal spinal cord and conus.

Follow up MRI

mri

Follow-up after 7 months revealed:

Marked progressive course of the multilevel inflammatory process and vertebral structural collapse of T8, T9, and T10 vertebral bodies and associated multilevel ill-defined epidural, pre-vertebral, and paravertebral soft tissue/cystic components most evident at D8 down to D11 and D12/L1 level.

Remarkable size regression of the related large posterior paravertebral and subcutaneous component at T7/8 level.

Right pleural effusion. 

Case Discussion

Multilevel process implicating several thoracic, lumbar and sacral vertebrae and some of the intervening discs with associated vertebral collapse, prevertebral, paravertebral, and epidural components. Findings are suggestive of an inflammatory process (T.B. spondylodiscitis) with a less likely possibility being of neoplastic nature.

Pathology:

Submitted material revealed degenerated connective tissue and disc cartilage with related micro caseating granulomas surrounded by epithelioid histiocytes with few Langhans-type giant cells. Picture suggestive of tuberculosis.

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