Age: 67
Sex: Male
Indication: Fever, back pain
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Case #11
Findings
- T6-T8 vertebral body fractures with 25% anterior height loss at T6, 70% anterior height loss at T7, and 50% anterior height loss at T8 with associated kyphosis. 2-3 mm bony retropulsion at each of these level, most pronounced at T7
- Fluid-filled fracture cleft just inferior to the T8 superior endplate with patchy areas of T2/STIR signal hyperintensity and enhancement in the T6-T8 vertebral bodies
- Minimal STIR signal hyperintensity in the intervertebral discs at T6-T7 and T7-T8
- T1-T4 superior endplate fractures, each with less than 25% height loss, without corresponding T2/STIR signal hyperintensity or enhancement
- Enhancing epidural soft tissue ventrally from T6-T8 without discrete peripherally enhancing collection, which contributes to moderate to advanced spinal canal stenosis at the level of T7
- Bilateral T6-T7 and T7-T8 facet joint effusions
- Moderate to advanced bilateral neural foraminal stenosis at T6-T7 and T7-T8
- No abnormal cord signal
- Extensive paraspinal soft tissue enhancement from T5-T8 with bilateral peripherally enhancing collections, measuring up to 1.5 x 2 x 4 cm on the left and 1 x 3 x 3 cm on the right at the level of T6-T7
- Moderate-sized left pleural effusion
Diagnosis
- Tuberculous spondylitis
Sample Report
Findings concerning for discitis/osteomyelitis at T6-T7 and T7-T8 with ventral epidural phlegmon and bilateral paraspinal abscesses. Paraspinal abscesses measure up to 1.5 x 2 x 4 cm on the left and 1 x 3 x 3 cm on the right at the level of T6-T7. The relative disc sparing and large paraspinal infectious components raise concern for tuberculosis as a potential etiology.
Associated acute/subacute pathologic fractures of the T6-T8 vertebral bodies with 25% anterior height loss at T6, 70% anterior height loss at T7, and 50% anterior height loss at T8 and associated kyphosis. 2-3 mm bony retropulsion at each of these level, most pronounced at T7, which in combination with epidural phlegmon results in moderate to advanced spinal canal stenosis at the level of C7. No abnormal cord signal.
Sterility-indeterminate bilateral T6-T7 and T7-T8 facet joint effusions.
Remote appearing T1-T4 superior endplate fractures, each with less than 25% height loss and no bony retropulsion.
Moderate-sized left pleural effusion.
Discussion
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References
- Hong SH, Choi JY, Lee JW, Kim NR, Choi JA, Kang HS. MR imaging assessment of the spine: infection or an imitation? Radiographics 2009; 29: 599-612.
- Rivas-Garcia A, Sarria-Estrada S, Torrents-Odin C, Casas-Gomila L, Franquet E. Imaging findings of Pott’s disease. Eur Spine J 2013; 22 Suppl 4(Suppl 4): 567-578.
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