Radiology Review

Everything’s Fine … Except His Spine

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Everything's Fine ... Except His Spine

A 25-year-old man is admitted to your facility for a possible infection in his spine. He reports a two-week history of severe back pain with no history of injury or trauma. Imaging performed at an outside facility suggested compression and erosion of his vertebral bodies at the thoracolumbar junction, and the radiologist raised concern for possible osteomyelitis and diskitis.

The patient is otherwise healthy and denies any medical problems. He denies drug use of any form. Review of systems is significant for a three-month history of anorexia and night sweats but no fever.

Physical exam reveals a healthy-appearing male with normal vital signs. His heart and lung sounds are normal.

A chest radiograph is obtained (shown). What is your impression?


 

Everything’s Fine … Except His Spine

ANSWER

The chest radiograph shows an approximately 3-cm cavitary lesion in the right upper lobe. Such a lesion can indicate lung abscess, neoplasm, or tuberculosis.

Subsequent workup determined that he did, in fact, have tuberculosis, with involvement in his spine (known as Pott disease).

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