Monday, 21 July 2014

A man with back pain

This man has back pain and is generally unwell:


What do you think is wrong, and what would you do next?


There is destruction of the left side of the T12 vertebral body, and an ill-defined mass occupying the left side of the abdomen. This is a coronal image from a CT:



This confirms destruction of the T12 vertebral body, with sclerosis of the existing bone. There is a large collection in the left retroperitoneal space. MRI confirmed the infection to originate from the T12-L1 intervertebral disc, with an enhancing epidural abscess compressing the spinal cord, as well as the large retroperitoneal abscess. The MRI shows the bone oedema involving both the T12 and L1 vertebral bodies.



ANSWER: Tuberculous spondylodiscitis.