Tuberculous spondylodiscitis: with CT biopsy

Case contributed by Dr Ian Bickle

Presentation

Low back pain. No fever. No history of respiratory disease.

Patient Data

Age: 62
Gender: Female
Modality: CT

CT chest

Destruction of both the vertebral body and right sided posterior elements of T10 with a large low-attenuation paravertebral component measuring up to 2 cm in depth. This extends into the central canal.

Further more minimal destruction of the anterior aspect of T11. The disease seems discocentric.

15mm nodule in the upper outer quadrant of the right breast.
Lungs clear.   
 

Modality: CT

1. Surface markers applied to skin to identify best route for biopsy of the destructive T10 mass with paravertebral soft tissue elements.

2. Biopsy needle sited prior to acquisition of sample.

3. Biopsy needle in mass where sample acquired (Trucut 'pusher type' needle).

Modality: Photo

Histology from CT guided biopsy confirmed tuberculosis.

Case Discussion

TB spondylodiscitis is one of the commonest manifestations of TB outside of the respiratory system.

It may be relatively innocuous in presentation and radiologically have appearances similar to metastatic bone disease.  The discocentric nature of the destruction, as in this case, is more suggestive of spondylodiscitis than metastases.

CT guided biopsy is one method of definitive diagnosis prior to treatment commencement.

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Case Information

rID: 47308
Case created: 11th Aug 2016
Last edited: 17th Aug 2016
Inclusion in quiz mode: Included

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