Sunday, February 13, 2011

Interesting Chest Xray (7)

A patient came with 1-month history of low back pain, and progressive lower limb weakness and numbness. Examination showed presence of neurological deficit, a MRI spine was done and shown as below.

Her chest Xray was like this:

Now you can link them and come to the diagnosis?

(Answer will be in comment)


Anonymous said...

TB of the spine?

pilocarpine said...

disseminated TB with TB spine of lumbar vertebrae?

叶子 said...

TB spine + Pulmonary Miliary TB?

Anonymous said...

Disseminated TB infection.

Darren Lee said...

So straightforward? No differentials? =)

YC said...

breast ca

Anonymous said...

Miliary TB with TB spine
Differential diagnosis: osteomyelitis with ARDS

Darren Lee said...

Alright! Here's the finding:

MRI lumbosacral spine showed loss of normal lordosis, L4 & L5 appear hyperintense on T2W and hypointense on T1W, suggestive of infective spondylitis.
Multilevel prolapsed intervertebral disc with spinal canal stenosis also noted.

CXR showed millet-sized nodular shadowing distributed throughout the lung parenchyma, suggestive of miliary tuberculosis.

Hence, the diagnosis is Miliary TB with infective TB lumbar spondylitis. Most of you got it right!;)

Other conditions which cause spondylitis with CXR changes:
Fungal infection esp Cryptococcal, coccidioidomycosis;
Staph aureus infection;
Osteomyelitis with pneumonia.

Related Posts with Thumbnails