CTICasesThoracic Spine Discitis-Osteomyelitis and Paraspinal Abscess due to Disseminated Mycobacterium avium complex
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Imaging findings
Chest radiography reveals subtle paraspinal line widening and loss of a thoracic disc space. Follow-up radiographs taken two weeks later show progressive loss of the disc space and a large, expanding paravertebral mass. Magnetic resonance imaging of the thoracic spine demonstrates extensive discitis and osteomyelitis with a large paraspinal/paravertebral abscess and epidural phlegmon extending into the spinal canal with associated marrow edema.
Key takeaways
Discitis-osteomyelitis is a disc-centered infectious process of the spine that should be suspected when a patient presents with paraspinal line widening and disc space narrowing on chest radiographs. While atypical mycobacteria like Mycobacterium avium complex are rare causes of spinal infections compared to Mycobacterium tuberculosis, disseminated MAC can present with severe, multi-drug resistant skeletal destruction in patients with advanced HIV/AIDS.
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