Atypical spinal tuberculosis mimicking malignancy: the utility of multimodality imaging evaluation

A previously well 50-year-old woman presenting with 2 months of worsening cough and back pain underwent a chest radiograph that incidentally revealed thoracic paravertebral soft-tissue swelling (figure 1). Further CT and MRI work-up showed a destructive T8–T10 paravertebral mass with associated vertebral abnormalities causing mild cord compression, along with multiple pulmonary and hepatic nodules (figure 2), overall suspicious for metastatic malignancy. The mass was subsequently sampled and drained under CT guidance, demonstrating caseating granulomata with acid-fast bacilli, thus confirming the diagnosis of spinal tuberculosis. Figure 2 MRI of the thoracolumbar spine with (A: sagittal) short tau inversion recovery (STIR) and (B: sagittal, C: axial—T8/T9 level) …