Pediatric Tuberculous Osteomyelitis

  • Etiology:
    — Hematogenous spread usually secondary to extraspinal infection from Mycobacterium tuberculosis
    — Infection may rarely start in vertebral endplate as in bacterial osteomyelitis discitis
    — Infection may also start in the central vertebral body and invade the spinal canal
  • Imaging:
    — Localizes to thoracic-lumbar region
    — Infection usually starts in anterior vertebral body and spreads under anterior longitudinal ligament to adjacent vertebrae
    — Subligamentous spread leads to descending paravertebral abscess out of proportion to vertebral involvement
    — Sparing of disc space early in disease process as mycobacterium lack proteolytic enzymes to digest disc space but discitis more common in children
    — Skip lesions
    — Soft tissue involvement
    — Vertebral body collapse leading to spinal alignment abnormalities with gibbus deformity eventually
    — Can involve posterior spine
    — Contrast enhancement of vertebral body and soft tissue
    — Central canal complications – subdural abscess, epidural abscess, cord ischemia and infarct
  • Imaging MRI:
    — T1WI: Decreased signal in anterior vertebral body
    — T2WI: Increased signal in anterior vertebral body
  • DDX:
  • Complications: Kyphosis
  • Treatment: Antibiotics
  • Clinical:
    — May be initial manifestation of tuberculosis in children
    — Common in developing world and HIV positive patients but increasing number of cases in developed countries

Radiology Cases of Tuberculous Osteomyelitis

Radiograph of tuberculous osteomyelitis.
AP radiograph of the right shoulder shows a well circumscribed lucent lesion in the right humeral epiphysis. There is no periosteal reaction.

Radiology Cases of Tuberculous Osteomyelitis of the Spine

Radiograph of tuberculous osteomyelitis
AP and lateral radiographs of the spine shows a calcified paraspinal posterior mediastinal soft tissue mass to the left of the spine from T10-T12 with relative sparing of the disc spaces. A subsequent PPD was positive.
Radiograph and CT and MRI of tuberculous osteomyelitis of the spine
Lateral radiograph of the spine (left) shows a marked kyphosis centered at the thoraco-lumbar junction. Sagittal CT without contrast of the spine (middle) shows the kyphosis is caused by destructive changes to the T10-L1 vertebral bodies. Sagittal T2 MRI without contrast of the spine (right) shows some compression of the spinal canal at this level.
MRI of tuberculous osteomyelitis of the spine
Sagittal T1 without contrast (above left) and T2 (above middle) MRI of the spine shows destruction of an intervertebral disc space and near-complete collapse of a vertebral body at the thoracolumbar junction with an associated kyphotic deformity. Sagittal T1 with contrast MRI (above right) shows a rim enhancing subligamentous fluid collection anterior to the vertebral body. Axial T1 with contrast MRI (below left) better shows the subligamentous fluid collection anterior to the vertebral body while a lower axial image (below right) shows a large rim enhancing abscess in the left posas muscle.