ABSTRACT
For these scenarios, further investigations should be targeted to look for possible underlying infections or malignancy.
This patient’s chest radiograph shows a calcified nodule in the upper lobe, indicating old primary tuberculosis. The spine radiograph in Fig. 98.1 shows partial collapse of T11 and T12 with loss of the intervening disc space. These findings and systemic symptoms raise the possibility of Pott’s disease (spinal tuberculosis), although other infection or malignancies cannot be completely excluded. The possible findings of vertebral osteomyelitis on plain radiography are bony destruction, wedge fractures, lytic or sclerotic lesions. If spinal cord compression is suspected, an urgent MRI of the spine and urgent referral to spinal surgeons should be organized. Any delay could potentially increase the possibility of permanent disability. Infections in the spine tend to involve the intervertebral discs early, whereas malignancy tends to affect the vertebrae themselves, often sparing the discs.
