Board Review 2 – Case 12

Neuroradiology board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

More description and the answer (spoiler!) are seen below the video.

This case shows multiple images throughout the body, with initial emphasis on the lumbar spine, where there is destruction of a lumbar vertebral body and surrounding abscess and inflammatory changes of the adjacent disc. There is relative sparing of the lumbar discs.

There is also disease elsewhere in the body, including an osseous lesion in a left-sided rib, ground glass and tree-in-bud nodules in the lungs, and nodular enhancing lesions in the brain. This makes you think about some sort of systemic process.

The diagnosis is: spinal tuberculosis

Spinal tuberculosis is a serious disease which can cause a discitis-osteomyelitis. The classic teaching, although it may not be true, is that the disease will spare the intervertebral discs. Other things to consider in the differential are metastatic disease and other infections.