Answer for BIR CoW 15 Mar 2026
Tuberculous spondylitis
Findings
Bone marrow STIR hyperintensities noted in the D7 and D8 vertebral bodies with endplate erosions and discal fluid. Minimal pre and paravertebral collection / phlegmon is noted with thickness of left 11.3 mm. Anterior epidural collection is also noted at D7-D8 level causing extradural cord compression, severe spinal canal compromise with intramedullary T2 hyperintensities. Bilateral severe neuroforamen narrowing at above level.
Discussion
MRI shows marrow edema in the D7 and D8 vertebral bodies with endplate erosions and discal fluid, consistent with spondylodiscitis. There is associated pre- and paravertebral inflammatory collection, along with an anterior epidural collection at the D7–D8 level causing severe spinal canal narrowing and extradural cord compression. Intramedullary T2 hyperintensity within the spinal cord suggests cord edema due to compressive myelopathy, correlating with the patient’s lower limb weakness. The involvement of adjacent vertebral bodies, disc space, and associated paravertebral and epidural collections in the thoracic spine favors an infective etiology, most suggestive of tuberculous spondylodiscitis (Pott disease) in the appropriate clinical setting. Differentials include pyogenic spondylodiscitis and neoplastic processes such as metastasis, although the presence of disc involvement and inflammatory collections favors infection. Overall, the findings indicate D7–D8 infective spondylodiscitis with epidural abscess causing significant spinal cord compression, which explains the patient’s neurological deficits and requires urgent clinical
Findings
Bone marrow STIR hyperintensities noted in the D7 and D8 vertebral bodies with endplate erosions and discal fluid. Minimal pre and paravertebral collection / phlegmon is noted with thickness of left 11.3 mm. Anterior epidural collection is also noted at D7-D8 level causing extradural cord compression, severe spinal canal compromise with intramedullary T2 hyperintensities. Bilateral severe neuroforamen narrowing at above level.
Discussion
MRI shows marrow edema in the D7 and D8 vertebral bodies with endplate erosions and discal fluid, consistent with spondylodiscitis. There is associated pre- and paravertebral inflammatory collection, along with an anterior epidural collection at the D7–D8 level causing severe spinal canal narrowing and extradural cord compression. Intramedullary T2 hyperintensity within the spinal cord suggests cord edema due to compressive myelopathy, correlating with the patient’s lower limb weakness. The involvement of adjacent vertebral bodies, disc space, and associated paravertebral and epidural collections in the thoracic spine favors an infective etiology, most suggestive of tuberculous spondylodiscitis (Pott disease) in the appropriate clinical setting. Differentials include pyogenic spondylodiscitis and neoplastic processes such as metastasis, although the presence of disc involvement and inflammatory collections favors infection. Overall, the findings indicate D7–D8 infective spondylodiscitis with epidural abscess causing significant spinal cord compression, which explains the patient’s neurological deficits and requires urgent clinical
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!