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)

8 comments:

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.

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