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Year |
2001 |
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Question Number |
156 |
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Category |
Select |
Question
A 4-year-old boy has a painful spinal deformity. Figures 51a through 51d show a lateral spine radiograph, whole body bone scan, a lateral T1-weighter MRI scan, and a needle biopsy specimen. What is the most likely diagnosis?
1- Tuberculosis
2- Metastatic neuroblastoma
3- Chordoma
4- Diskitis
5- Ewing’s sarcoma
Figures
Answer (click for answer)
Answer 1
The x-ray shows destruction of a thoracic vertebral body and disc space and a kyphotic deformity. The bone scan shows a moderate amount of increase uptake in the thoracic spine in the area of the lesion. The MRI shows complete destruction of a thoracic vertebral body with a mass effect compression of the spinal cord.
The article states that infections of the spine first invade to the paravertebral soft tissue and then invade the end plate secondarily. The report the earliest finding on MRI of the spine in TB is rarefaction of the vertebral end plate.
Remember infection crosses the disc space and tumor doesn’t. Therefore the three tumors are ruled out. Diskitis is a self-resolving disorder that would not cause such destruction.
In addition the pathology shows acid-fast bacilli, pathopnuemonic for TB.
Reference: Mushkin AY, Kovalenko KN: Neurological complications of spinal tuberculosis in children. Int Orthop 1999; 23:210-212.
Sudarshan K: Tuberculosis of bones and joints. J Bone Joint Surg Am 1997; 26:511-18.