PMC9282816_01
Anteroposterior (a) and lateral (b) radiographs of thoracic spine showed scalloping of the T7 vertebral body on the left lateral aspect along with nonvisualization of the left pedicle and erosion of the adjoining rib.
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T7 left pedicle and adjoining rib [Figure 1]. The MR showed; a left-sided T7 enhancing periarticular erosive lesion, marrow edema in the posteromedial portion of the left 7th rib, the left posterolateral portion of the T7 vertebral body, and lateral left T7 pedicle. There was also thickening/ enhancement of the synovium of the left 7th costotransverse joint with enhancing soft tissue elevating the overlying pleura, and abutting the descending aorta [Figure 2].
(a and b) Magnetic resonance imaging showed enhancing periarticular erosive lesions and marrow edema in the posteromedial portion of the left 7th rib, left posterolateral portion of the D7 vertebral body, and lateral portion of the left T7 pedicle, thickening and enhancement of synovium of the 7th costotransverse joint with enhancing soft tissue elevating the overlying pleura, and abutting the descending aorta. a: Yellow arrow shows coronal MRI (T2 )image showing enhancement of the soft tissue. b: Yellow arrow shows saggital MRI (T2)imaging showing periarticular erosive lesions and marrow edema (left T7 pedicle)
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T7 left pedicle and adjoining rib [Figure 1]. The MR showed; a left-sided T7 enhancing periarticular erosive lesion, marrow edema in the posteromedial portion of the left 7th rib, the left posterolateral portion of the T7 vertebral body, and lateral left T7 pedicle. There was also thickening/ enhancement of the synovium of the left 7th costotransverse joint with enhancing soft tissue elevating the overlying pleura, and abutting the descending aorta [Figure 2].
Computed tomography-guided biopsy done from the soft-tissue lesion adjacent to the left 7th costotransverse joint. Yellow arrow shows Axial CT images showing location from where biopsy done.
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A CT-guided biopsy was diagnostic for TB; it demonstrated caseous necrosis with epithelioid and Langerhans giant cells [Figure 3].
(a and b) MRI at 12 months follow-up showed complete resolution of the erosive lesions and associated enhancing soft tissue with no residual enhancing lesion or collection. a: Yellow arrow shows coronal MRI (T2) image showing resolution of lesion. b: Yellow arrow shows Sagittal MRI (T2) image showing resolution of lesion.
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At follow-up (12 months), the patient showed clinical and radiological signs of healing [Figure 4].