1. MedPix Medical Image Database COW - Case of the Week Case Contributor: Steven J Goldstein Affiliation: University of Kentucky

2. MedPix No: 14097 - History Pt Demographics: Age = 24 y.o. Gender = man 24 year old recent immigrant from Bangladesh. Referred to hospital for MRI by the local health department with diagnosis of spinal TB Downloaded by (-1)

3. MedPix No: 14097 - EXAM & LABS Not available

4. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

5. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

6. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

7. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

8. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

9. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

10. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

11. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

12. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

13. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

14. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

15. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

16. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

17. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

18. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

19. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

20. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

21. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

22. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

23. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

24. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

25. Tuberculosis of the Lumbar Spine Destructive lesion at L2 with extension into right psoas muscle and ventral paraspinal rim enhancing collection consistent with abscess. Downloaded by (-1)

26. Tuberculosis of the Lumbar Spine MRI done 8 months previously prior to therapy, shows all masses to be larger including the psoas abscess. - Downloaded by (-1)

27. Tuberculosis of the Lumbar Spine MRI done 8 months previously prior to therapy, shows all masses to be larger including the psoas abscess. - Downloaded by (-1)

28. Tuberculosis of the Lumbar Spine MRI done 8 months previously prior to therapy, shows all masses to be larger including the psoas abscess. - Downloaded by (-1)

29. Tuberculosis of the Lumbar Spine MRI done 8 months previously prior to therapy, shows all masses to be larger including the psoas abscess. - Downloaded by (-1)

30. FINDINGS Destructive lesion at L2 with ventral paraspinal enhancing collection consistent with abscess.

31. DIFFERENTIAL DIAGNOSIS What is your Differential Diagnosis? trauma - Pyogenic spondylodiscitis - metastatic tumor - Lymphoma - Pott*s disease

32. Diagnosis: Spinal Tuberculosis/Potts Disease Dx Confirmed by: Imaging and provided History

33. DISCUSSION