A 22-year-old previously healthy male patient presented to the emergency department with a two-month history of fatigue, low-grade fever and progressive dyspnea. Chest radiography showed a large left pleural effusion with subtle bilateral enlargement of the superior mediastinum (Figure 1, arrows). Thoracentesis was performed for therapeutic and diagnostic purposes. Pleural fluid analysis was consistent with lymphocyte-rich exudate.
Computed tomography (CT) of the chest revealed a pre-vertebral sub-ligamentous collection, extending bilaterally, and predominantly on the left (Figure 2, arrows) with an associated pleural effusion. Sagittal reformatted CT image in bone window showed extensive lysis of T4, T5, and T6 vertebral bodies, with some peripheral sclerosis and mild decrease in T5–T6 and T6–T7 disk height (Figure 3, arrows).
Imaging findings were consistent with tuberculous spondylodiscitis (confirmed by microbiological studies), an associated prevertebral collection and reactive left pleural effusion.
Tuberculous spondylodiscitis, also known as Pott’s disease, refers a to spinal infection caused by mycobacterium tuberculosis. It is characterized by an insidious onset and gradual progression of the disease compared to pyogenic spondylodiscitis. Although the final diagnosis can only be made by direct analysis of the infected tissue, constellation of radiological findings, clinical manifestations and blood tests results can suggest the diagnosis with high degree of confidence .
The authors have no competing interests to declare.
Lee, KY. Comparison of pyogenic spondylitis and tuberculous spondylitis. Asian Spine Journal. 2014 Apr 1; 8(2): 216–23. DOI: https://doi.org/10.4184/asj.2014.8.2.216