Tuberculous spondylitis presenting as severe chest pain

Abstract

This case report describes a 32-year-old male who presented to an emergency department with severe chest pain and a history of cough, fever, night sweats, loss of appetite and weight. Chest radiography revealed a left upper lobe consolidation and multiple compression deformities in the thoracic spine. Magnetic resonance imaging demonstrated significant kyphosis and vertebral plana at two thoracic levels. Anterior compression of the spinal cord and adjacent soft tissue masses were also noted.

Keywords: chest; magnetic resonance imaging; mycobacterium tuberculosis.; pain; spondylitis; tuberculosis.

Figure 1

Chest x-ray showed left midzone consolidation, consistent with pulmonary tuberculosis. An incidental finding was severe wedging of T11 and to a lesser extent T9.

Figure 2

(A) Sagittal T2W SE, (B) axial T1W SE with gadolinium at T11–T12 disk level and (C) coronal T1W SE with gadolinium showed progression of wedging at T9 and T11 in comparison to the chest radiograph. This resulted in mild kyphosis and gibbus dislocation. Subligamentous and epidural abscess collections were noted with compression of the spinal cord and the lateral recesses (A, B). Bone marrow edema and early changes were noted in the vertebral body of T3 (A). Notice the preservation of disk signal and height adjacent to the involved vertebrae (A, C).