Case Of the Week (COW) 29 Sep 2013
Answer:
NEURAL ARCH TB
Findings:
X ray - L4 spine- absence of LEFT pedicle ( WINKING OWL SIGN). CT - Erosion of posterior vertebral body margin with adjacent superior end plate involvement of L4 with spinous process eroded. Permeative lytic lesion of L4 lamina & spinous process with specks of calcification noted – (exploded patterns) which is specific for TB.
Discussion:
NEURAL ARCH TB (NAT) Posterior element involvement in tuberculosis is rarely seen and is usually estimated to occur in about 0/2% to 2% of all spinal cases Spine is a common site for extrapulmonary involvement. Anterior vertebral column is mostly affected in three distinct patterns - paradiscal, central and anterior in decreasing frequency Extremely rare and atypical feature of spinal T.B is posterior elements affection which due to its rarity is not brought into the classifications Massive destruction of the posterior arch which is due to resorption of the posterior bony element is the cardinal picture Parts of the vertebral arch are vanished and usually replaced by the granulomatous mass.
Contributed By:
Dr, Sundareswaran, Dr. Babu Peter, Dr. Manimegala
Barnard Institute of Radiology
Answer:
NEURAL ARCH TB
Findings:
X ray - L4 spine- absence of LEFT pedicle ( WINKING OWL SIGN). CT - Erosion of posterior vertebral body margin with adjacent superior end plate involvement of L4 with spinous process eroded. Permeative lytic lesion of L4 lamina & spinous process with specks of calcification noted – (exploded patterns) which is specific for TB.
Discussion:
NEURAL ARCH TB (NAT) Posterior element involvement in tuberculosis is rarely seen and is usually estimated to occur in about 0/2% to 2% of all spinal cases Spine is a common site for extrapulmonary involvement. Anterior vertebral column is mostly affected in three distinct patterns - paradiscal, central and anterior in decreasing frequency Extremely rare and atypical feature of spinal T.B is posterior elements affection which due to its rarity is not brought into the classifications Massive destruction of the posterior arch which is due to resorption of the posterior bony element is the cardinal picture Parts of the vertebral arch are vanished and usually replaced by the granulomatous mass.
Contributed By:
Dr, Sundareswaran, Dr. Babu Peter, Dr. Manimegala
Barnard Institute of Radiology