Tuberculous spondyodiscitis

Case contributed by Dr Ian Bickle

Presentation

Right neck swelling intial cause for presentation. Incision and drainage identified TB. Subsequent imaging performed. Asymptomatic from chest and musculoskeletal perspective.

Patient Data

Age: 30
Gender: Female
CT

Left upper lobe consolidation and airspace change.  No cavitation.

Paratracheal and pre-aortic lymphadenopathy.

Multilevel vertebral body destructive lesions with paravertebral soft tissues masses.

Post surgical change at the left side of the neck.

MRI

Multilevel T2 hyperintense vertebral bodies of varying degrees, namely C3, C4, C6, T1, T2, T5, T6, T8, T10, T11, T12, L1, L2, L4, L5, S1 and S2.

Between C3 and C5 there is a right cervical abscess and a left supraclavicular abscess.

C7/T1 anterior left paravertebral abscess.

T6 vertebra plana with an associated large paravertebral and epidural abscesses encroaching and narrowing the spinal canal, but without any cord compromise.

T10/11 large paravertebral and left paraspinal abscess.

L1/2 paraspinal and left para vertebral abscesses.

Loculated paraspinal abscesses is seen at T12 to L4 and T7-T8.

Mediastinal lymphadenopathy.

 

Case Discussion

A rather unusual presentation for a young patient with such diffuse and dramatic lung and spinal ramifications of TB.

The patient attended with a neck lump from outpatients, which on aspiration yielded pus.  Incision and drainage was performed and microbiology identified Mycoplasma.  

CT chest then performed to assess for tuberculosis.   This was identified along with spinal destruction which resulted in a MRI spine.

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Case information

rID: 53768
Case created: 6th Jun 2017
Last edited: 13th Jul 2017
System: Spine
Inclusion in quiz mode: Included

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